Burying the treatment of lumbar intervertebral disc prolapse 
  

  Definition

    For various reasons (such as sprains, strain, etc.) to be squeezed lumbar intervertebral disc, lumbar traction and reverse the result in partial or total rupture of the fibrous ring, resulting in backward or posterolateral nucleus pulposus prolapse, resulting in low back pain and other comprehensive syndrome, fibrous ring called the lumbar herniated nucleus breakdown, referred to as lumbar disc herniation. The disease occurs mainly in young and middle-incidence site was more common in lumbar disc 4 to 5, L5 callosum, followed by a plate, and sometimes both upper and lower intervertebral disc disease.

 

    American Academy of Orthopaedic Surgeons naming of lumbar disc disease were defined as follows: 

    First, the normal intervertebral disc intervertebral disc degeneration-free, all are in the intervertebral disc intervertebral disc tissue.

    Second, the disc bulging (bulging) intervertebral disc intervertebral ring beyond the scope of uniformity, the limitations of disc tissue was not prominent.

Third, the disc (protruded) intervertebral disc intervertebral space limitations of the shift over. Shift disc tissue is still connected with the original disc tissue, the basal diameter greater than the Ministry of continuous shift beyond the intervertebral disc part.

IV, intervertebral disc prolapse (extruded) shift is greater than the diameter of the base disc tissue Ministry continuously, and move outside of the intervertebral space. Prolapse of the intervertebral disc ruptured intervertebral disc tissue is greater than the gap, and through this crack in the spinal canal.

China also called on the lumbar disc herniation ruptured lumbar intervertebral disc disease, lumbar disc herniation, lumbar disc herniation between the cartilage, vertebral cartilage rupture psychosis title. Although the name and meaning of these diseases are different, the current title still unified as follows: lumbar disc herniation.

Categories

Disc is located between two adjacent vertebrae, internal and external, outside the two form, external to annulus, a ring arranged by the multi-fiber cartilage ring formed around the nucleus around the nucleus prevents the protruding , tough and elastic fibers; inside the nucleus, is a flexible rubbery material, the role of a moderating impact. Adults, degenerative disc changes, thicker fibers in the annulus, the occurrence of broken glass degeneration resulting in the final, so discs lose their flexibility, can not bear the pressure of the original commitment. In overuse, sudden changes in body position, and fiercely violent action or impact, the annulus can bulge outward, so the nucleus can be broken through the cracks protruding annulus, which is called the disc.

Lumbar disc can be divided into:

1, lumbar disc herniations: the annulus is not completely broken, the nucleus protrudes from the breakage of nerve root compression;

2, lumbar disc herniation: annulus rupture, the nucleus out from the rupture, nerve root compression;

3, lumbar disc prolapse: annulus rupture, the nucleus out from the rupture, the breaking of the posterior longitudinal ligament, free to the spinal canal, spinal nerve root compression.

Disease groups

(1) in terms of age: Lumbar disc herniation occurs in young adults

(2) in terms of gender: Lumbar disc herniation in the pathogenesis of more common in men than women when men think that men and women as the ratio is ~:

(3) from the body sense: as too fat or too thin of people prone to cause lumbar disc

(4) from the professional sense: the larger the labor intensity of industrial workers, but more common mental point of view it does not lower the incidence of

(5) from the position in terms of: work posture and frequent staff scheduling desk clerk standing and other textile workers were more common

(6), speaking from the living and working environment: often in cold or humid environment were to some extent, be induced by the conditions of lumbar disc herniation

(7) from the women speak in different periods: before and after pregnancy and menopause for women the risk of lumbar disc herniation

(8), congenital dysplasia or deformity of the spine even the spirit of the people too much tension in smokers susceptible to low back pain and cough may cause spinal disc pressure and increased the pressure on them are prone to degenerative changes

Cause

Etiology of lumbar disc herniation, there is internal but also external, internal master is degenerative change; external causes are trauma, strain or fatigue, chills by the wet and so on.

First, the lack of intervertebral disc degeneration disc blood supply, repair, energy is weak, in daily life from all aspects of intervertebral disc extrusion, stretching and torsion, easy to make the nucleus pulposus, annulus fibrosus, cartilage aging, resulting in fiber rings are easily broken, Erzhi disc.

Second, long-term vibration while driving cars and tractors during the long-term bumps in the seat and the state, the pressure disc is too large, can lead to disc degeneration and prominent. At the same time also affect the vibration disc nutrition, the impact on microvascular disc can be accelerated.

Third, over-load overloaded when the waist, long engaged in bending, such as: coal miners or construction workers, need long-term bending heavy objects, weight more than 100 disc kPa / cm or more, which led to disc fiber ring rupture.

Fourth, physical trauma was arranged in the lumbar lordosis, intervertebral disc after the former thick thin waist injury when the patient, falls, flash back, etc., the intervertebral disc backward that may cause disc back outstanding.

Fifth, early lumbar puncture lumbar puncture in the post-1935 have found that disc space narrowing and disc coverage.



Clinical manifestations

(A) low back pain, radiating pain and the side of the lower limbs are the main symptoms of the disease. Low back pain often occurs in the leg before, but also both simultaneously; most of them have a history of trauma, but also the absence of explicit incentives. Pain has the following characteristics:

1. Radiating pain along the sciatic nerve conduction, direct access to the lateral leg, dorsal foot or toes. Such as lumbar 3-4 highlight the gap, because the oppressed L4 nerve root, resulting in pain radiating to the front of the thigh.

2. All the action of increased cerebrospinal fluid pressure, such as coughing, sneezing, and bowel and so on, can aggravate back pain and radiating pain.

3. Activities, the pain intensified, after the break reduced. Bed position: the majority of patients with lateral position, and limb flexion; individual cases of severe pain in the various positions are only the hip flexor knees kneeling on the bed to relieve the symptoms. Combined lumbar spinal canal stenosis, often intermittent claudication.

(B) scoliosis: lumbar major curve in the next, when the more obvious flexion. Highlight the direction of bending depends on the relationship between nucleus and nerve roots: such as prominent at the front of the nerve roots, trunk usually to the risk of scoliosis.

Left: nucleus pulposus protrusion in front of the nerve roots, spinal curvature to the patient, such as bending to the contralateral pain is exacerbated

Right: The nucleus pulposus protrusion outside the front of the nerve roots, spinal curvature to health, such as pain to the affected side of the bend is increased

(C) restricted spinal nucleus prominent nerve root compression, tension in the psoas muscle was protective, can occur in unilateral or bilateral. The psoas muscle tension, physiological lumbar lordosis disappeared. Spinal flexion, extension activities restricted, flexion or extension can occur when the pain radiating to the side of the lower limbs. Often only one side lateral bending is limited, thus can be used with spinal tuberculosis or tumors.

(D) radiating pain associated with herniated discs and lumbar tenderness of the spinous process with limited ipsilateral tender points, and accompanied by pain radiating to the leg or foot, this point is important for diagnosis.

(E) straight leg raising test was positive due to personal physical differences, the test was positive the degree of non-uniform standards, we should pay attention to both sides of the comparison. Ipsilateral leg is limited, and feel pain radiating to the leg or foot is positive. Sometimes the affected side leg raise healthy limb numbness occurs, the Department of traction caused by ipsilateral nerve, this point has great value in the diagnosis.

(Vi) neurological examination

 Prominent lumbar 3-4 (L4 nerve root compression), the knee reflex may have decreased or disappeared, calf hypoesthesia.

4-5 prominent lumbar (L5 nerve root compression), the dorsal anterolateral leg hypoesthesia, and 2 toe extensor muscle strength is often diminished.

A prominent lumbar 5 sacral (S1 nerve root compression), the lower leg and foot after external lateral hypoesthesia, 3,4,5 toe weakness, Achilles tendon reflex diminish or disappear. Limb nerve compression symptoms may have severe muscle atrophy.

Such as the prominent large, or for the central herniation, or rupture of annulus prominent nucleus to the spinal canal by debris, there may be more extensive damage to the nerve root or cauda equina symptoms, ipsilateral numbness area often more extensive and may include herniated nucleus below the level of ipsilateral hip and femoral lateral, leg and foot. Prominent central nerve injury often have symptoms of both lower limbs, but heavier on one side; should pay attention to check the saddle felt, often the side of the loss, and sometimes both sides of the loss, often out of control urine, wet pants bedwetting, constipation, sexual function obstacles, and even some or most of the two lower limbs paralyzed.

Auxiliary examination

Lumbosacral vertebrae are to be shot, lateral view, if necessary, add photos so oblique film. Scoliosis often, sometimes visible disc space narrowing, vertebral edge of the lip-like proliferation. Although X-ray findings can not serve as a basis for diagnosis of lumbar disc herniation, but can be to exclude a number of diseases, such as spinal tuberculosis, osteoarthritis, fractures, tumors, and spondylolisthesis and so on. Patients with severe or atypical cases, difficulty in diagnosis may be considered for spinal cord lipiodol contrast, CT scan and MRI and other special checks to confirm the diagnosis and prominent location. The examination was normal except for patients with lumbar disc herniation can not completely.

Differential Diagnosis

(A) of the adjacent lumbar vertebral joint disorders constitute the upper and lower lumbar facet joints, the synovial joints, the nerve distribution. After the joint when the upper and lower articular process of the relationship is not normal, acute pain can be produced by synovial incarceration, chronic cases can be generated after the traumatic joint arthritis, appears low back pain. Such pain occurred in 1.5 cm at the spinous process, may have the same side of the hip or thigh pain radiating, easily mixed with lumbar disc herniation. The disease is generally not more than knee pain radiating, and not associated with feeling, decreased muscle strength and reflexes such as the signs of nerve root injury. Differential diagnosis of difficult cases, in the vicinity of lesions Facet injection of 2% procaine 5 ml, such as the symptoms disappear, you can rule out the lumbar disc herniation.

(B) of the lumbar spinal canal stenosis with intermittent claudication is the most prominent symptoms, the patient private prosecution after walking some distance, leg trapped acid, numbness, weakness, must crouch before they may continue running after the break. Cycling can be asymptomatic. Patients complained of little more than the signs, are also important features. A small number of patients with nerve root injury performance. Severe central stenosis, there may be incontinence, spinal cord angiography and lipiodol CT scan and other special checks can be further confirmed.

(C) the limitations of spinal tuberculosis in early spinal tuberculosis can stimulate nearby nerve root, causing low back pain and lower extremity radiating pain. Spinal tuberculosis with TB systemic reactions, back pain than the drama, X-ray films can be seen the destruction of vertebral body or pedicle. X-ray CT scan of the vertebral body can not display the early limitations of tuberculosis have a unique role.

(Iv) increased vertebral metastases pain, aggravated at night, patients debilitating, can be found in the primary tumor. X-ray shows osteolytic destruction of vertebral body.

(E) and the cauda equina meningioma tumors as a chronic progressive disease, non-stop improvement or self-healing phenomenon, often incontinent. CSF protein increased, Kui's test showed that obstruction. Spinal angiography can confirm the diagnosis.

Symptoms: low back pain, lower extremity radiating pain, numbness, cold sensation, and intermittent claudication, symptoms of cauda equina

    Most patients with lumbar disc herniation, according to clinical symptoms or signs to make the correct diagnosis. The main symptoms and signs are: ① back pain merge "sciatica", radiation to the leg or foot, straight leg raising test was positive; ② 4-5 in the lumbar spine or lumbar 5 sacral 1 significantly between the lateral ligament of the tender point , while there to the lower leg or foot pain radioactive; ③ outside before or after the lateral calf skin hypoesthesia, toe weakness, ipsilateral Achilles tendon reflex diminish or disappear. X-ray can rule out other bone lesions.

Treatment

Surgical therapy include fusion, decompression, posterior surgery, in addition, there are between between surgical and non surgical intervention, such as percutaneous aspiration of nucleus pulposus, collagen dissolving enzymes surgery, laser disc solution nuclear technique and so on.

Non-surgical treatment, also known as conservative treatment, commonly used methods are: heat therapy, direct external application of Chinese law, a variety of Chinese and Western medical treatment, traction therapy, bone, massage therapy, physical therapy (such as magnetic therapy), acupuncture, Chinese medicine Fumigation topical, and even simple bed rest is a traditional and effective method of treatment. Oral absorption of drugs through the stomach, digestion, decomposition, and finally through the blood, before the drug given to local input, the whole process needs to get through the barrier layers of the lesion site, then efficacy is running low, so the effect is very slow and low efficiency, and the clinical application of these methods can only alleviate the symptoms of pain, functional recovery can not be reversed, bone repair is impossible. And oral medication on the liver, kidney, gastrointestinal damage is enormous.

Use more conservative treatment methods to minimize patient injury treatment, it is often referred to as "conservative treatment." 80% to 90% of patients treated by non-surgical methods and more, this method is safe for most patients, the treatment costs are relatively cheap and better efficacy.

Embedding a complete minimally invasive therapy restored normal function of the disc, after embedding in patients with appropriate activities, do not need bed rest, non-invasive therapy embedding injury, no pain, low cost, is currently the best non-surgical therapy means. Trained clinician can be applied to promote minimally invasive acupoint catgut embedding therapy for patients afflicted by the disc herniation to relieve pain is the outstanding advantages of this therapy.

Burying treatment

1 apparatus: Luoyang Allen Health Trading Company No. 6, 12-16 cm long disposable sterile needle embedding (one note line pin), the collagen No. 00-0-1-4 line about 2 cm long cut into the number of section, soaked in 75% alcohol use. Lumbar disc herniation based on the degree of disc herniation, mild swelling line with a 00, highlighted with a 0-1 line of moderate and severe prolapse with Line 4.

.2 Acupoints: check disc lesions 1 cm lateral to spinous process tenderness. Distribution Point: Yanglingquan, after the blood stream after embedding.

3 METHODS: Patients lay on position, a thin pillow belly pad, select the right points, local skin routine disinfection, sterile forceps tweezers to take a stand collagen line, put the needle in the front line completely into the collagen pinhole, will quickly penetrate the foramen needle. Intervertebral disc lesions taken 1 cm lateral to spinous process orientation, in the next 3 cm lateral to vertebral body at the center of the needle point is, L2-L5 in a 45-degree angle upward direction obliquely into the vertebral foramen, L5/S1 disc prominent in the L5/S1 1 cm between the adjacent open position adjacent to open in the middle of the next vertebral body was 2.5 cm at the needle points to 45 degrees obliquely upward direction into a vertebral foramen. A sense of frustration when the tip has to prove that the needle has reached the foramen needle embedding mouth, then quickly move the needle bomb into the core, the collagen in the line of shells into the intervertebral foramen, and then withdraw the needle, place the insertion point embedding bleeding and paste the Band-Aid, Zhu Huanzhe 2 days without washing, to prevent pin tract infection. After embedding do not immediately stop the bleeding if the pinhole bleeding, bleeding 10-20 ml is appropriate, not bleeding and the need for blood cupping. Embedding one every 15 days, 3 times for one course.

Discussion

Lumbar disc herniation is a common disease, its treatment for many, but more the effect is not ideal, and the long course of treatment. Poor economic conditions and the number of patients in remote areas, there is no time, energy and money to the hospital for treatment every day and had to drop out treatment, greatly affected the normal life of patients with disc herniation. Catgut embedding therapy using minimally invasive medical devices do not need expensive, the implementation time is short, and no anesthesia, little pain, financial burden is small, fewer number of treatments to avoid the rush between patients, the pain of travel fatigue. After burying the treatment of minimally invasive general pain, numbness immediately reduced, about 1 month up to the best effect, foraminal burying the bones of the body back to the prominence of the spinal cord position, the deformation of the spine return to normal state, restoring the normal physiological function, less recurrence and lasting effect. Patients more likely to be suitable for clinical application and promotion.

Minimally invasive acupoint catgut embedding therapy based on the theory of traditional Chinese medicine, is buried in the acupuncture needle retention and needle based on the mechanism of action evolved, catgut embedding the beginning point for the mechanical stimulation to produce acupuncture effect, after the chemical stimulation, with the decomposition of collagen lines, liquefaction, absorption, and moderate on the point to have a lasting positive stimulus. As a one-time minimally invasive needle burying the body length is 7 cm, burying the needle points to the disc is 9 centimeters from the general, after piercing needle embedding the general population just outside the intervertebral foramen to promote core needle after the 2 cm line directly stimulate collagen outstanding disc marrow bones of the body, marrow bones of the body of a herniated disk, but after the auto-stimulated contraction, coupled with line role in promoting collagen to disc prolapse back into place quickly. Line in collagen stimulation, as well as supporting dual role, the disc back to its normal position, while the damaged annulus line in the stimulation of collagen began to repair the damaged annulus 10-15 days after return to normal, the line of the absorption , the disc structure and function returned to normal. Relieve nerve root compression pain, numbness, and so a series of symptoms quickly disappeared.

 Bleeding after burying the nerve root release of local blood stasis, so that local engorgement of small blood vessels of the symptoms of nerve root compression improve local blood circulation of the intervertebral foramen with collagen protein is absorbed in the front line of a long stimulus play together and clear the meridians, promoting blood circulation, swelling and pain of the role to promote disc peripheral vasoconstriction, improvement of microcirculation, increase blood flow, interstitial edema disappeared. Transforaminal approach under the needle tips burying one bar to the intervertebral foramen just outside the mouth, will not damage the nerve root and security, coupled with collagen after the line is playing into the intervertebral foramen to stimulate contraction of prominent nucleus, so prominent nucleus also satisfied, which lifted the dural sac and nerve root compression, numbness, rapid relief of pain, many patients who previously required surgery relieved the pain of a knife.

Embedding a complete minimally invasive therapy restored normal function of the disc, after embedding in patients with appropriate activities, do not need bed rest, non-invasive therapy embedding injury, no pain, low cost, is currently the best non-surgical therapy means. Trained clinician can be applied to promote minimally invasive acupoint catgut embedding therapy for the discount by the disc herniation to relieve pain in patients What is the outstanding advantage of this therapy.

Minimally invasive burying disposable sterile needles, has the following advantages: First: The ethylene oxide sterilization, the full realization of the two sterilization two strict aseptic packaging. Second: cheap, compact and flexible, the use of succeed. Through clinical validation, with its implementation is truly minimally invasive acupoint catgut embedding method. No specific figure, you can reduce the operator fatigue and increase your efficiency of acupuncture to improve the embedding time, controlled needle core, to prevent the slide from the top of the line, can be a multi-line and a needle point and more to the point embedding, free without taking into account the core needle to advance and retreat, you can not burying the pain under local anesthesia reaction, reduce the patient fears and concerns embedding therapy.

Most patients within 1 week after burying, local soft and comfortable feel a sense of soreness, the equivalent of leaving a sense of qi needle, is another example of catgut embedding more sustainable and effective than acupuncture to stimulate acupuncture points, and therefore more effective consolidation of the therapy safe and reliable, in addition to individual course of treatment a slight fever, the less prone to infection or nerve injury abnormal reactions, fever occurred line of collagen protein in vivo allogeneic response is a normal phenomenon, generally 2 ~ 3 days the natural ease.