What should I do if I have a lumbar disc herniation?

Written by Na Hong Wei
Orthopedics
Updated on September 12, 2024
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After a lumbar disc herniation, it is essential to first determine the type of herniation you have. Clinically, lumbar disc herniations can be categorized into protrusion, prolapse, extrusion, and sequestration, with protrusion being the most common. Once the type of herniation is identified, treatment can begin. Currently, the treatment methods are diverse and can be broadly classified into six categories. The first is internal treatment with traditional Chinese medicine. Traditional Chinese medicine classifies lumbar disc herniation into four types, each treated with different medications. The second is external treatment with traditional Chinese medicine, such as herbal fumigation and plaster application. The third is traction, which includes bed traction and manual massage. The fourth is acupuncture. The fifth category includes other therapies, starting with resting on a hard board bed for approximately a week, followed by techniques like small needle knife therapy, intradiscal injection, sacral canal injection, and ozone therapy. If conservative treatments prove ineffective, or if symptoms worsen during treatment, surgical intervention may be necessary. Surgical treatment is generally indicated in the following four situations: patients with spinal stenosis, patients who do not respond to conservative treatment or who experience recurrent symptoms after recovery, patients with worsening neurological symptoms, and patients with central lumbar disc herniation causing incontinence. These are the conditions mentioned above.

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Written by Na Hong Wei
Orthopedics
1min 32sec home-news-image

Is a herniated lumbar disc serious?

Lumbar disc herniation is primarily due to degeneration of the lumbar disc or secondary pathological changes caused by this degeneration, which then stimulate blood vessels, nerve roots, and the spinal cord, leading to a series of clinical symptoms. Lumbar disc herniation is categorized into four types. The mildest type is the bulging type, followed by the protruding type, the more severe extrusion type, and finally the most severe, the sequestration type. Generally, lumbar disc bulging is relatively mild and conservative treatment is usually effective. Depending on the site and degree of compression, lumbar disc herniation may be treated conservatively, but some cases require surgical intervention. Most cases of disc extrusion require surgery because the extrusion leads to spinal stenosis, compressing all or part of the blood vessels, and it can also compress the spine and nerve roots, causing irreversible damage, and medications or massages can't reverse the condition. The fourth point concerns lumbar disc prolapse, meaning the nucleus pulposus falls into the spinal canal through the tear. This is one of the few emergencies seen in spinal surgery. If this occurs, immediate surgical treatment is necessary. Therefore, the severity of lumbar disc herniation mainly depends on the type and degree of the herniation, as well as the location and direction of the herniation, and which treatment method needs to be used.

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Written by Na Hong Wei
Orthopedics
1min 40sec home-news-image

Lumbar disc herniation has what manifestations?

Lumbar disc herniation has the following clinical manifestations. First, lower back pain accompanied by unilateral radiating pain in the lower limbs. Second, numbness in the localized area. Third, weakness in the toes. Fourth, decreased temperature in the affected limb. Upon examination, the first finding is a reduced natural anterior curve of the lumbar spine, which we refer to as a flat or board-like back. Second, it can also cause the lumbar spine to bend to one side, possibly toward the affected side or the healthy side, depending on the location of the herniation. Third, there is a fixed tender point beside the lumbar spine, which plays an active role in diagnosis and treatment. Fourth, due to pain, there is a limitation in the movement of the lower back; normally, the lumbar spine can flex 45 degrees forward, extend 20 degrees backward, and bend 30 degrees to each side. If these ranges of motion are not achievable, it indicates a significant limitation in lumbar activity. Fifth is the neurological localization examination, which primarily involves different sensory disturbances, motor disturbances, or muscle atrophy depending on the site of compression. There are also some special tests, like the straight leg raise test, reinforcement test, healthy side leg raise test, as well as the neck flexion test and femoral nerve stretch test. Lastly, additional diagnostic tests like CT or MRI can provide specific information on the location and stage of the lumbar disc herniation.

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Written by Na Hong Wei
Orthopedics
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Is moxibustion effective for lumbar disc herniation?

As an important treatment method in traditional Chinese medicine, moxibustion has very good therapeutic effects for treating lumbar disc herniation. As long as the acupuncture points are correctly selected, the treatment effect is very good. Specifically, if you choose to use moxibustion for treatment, the main point would be the Jiaji points, and this should include the two adjacent vertebrae. For example, for a L4-L5 disc herniation, you should select points L1 to L5. Auxiliary points should be chosen based on different symptoms of the patient, in combination with different acupoints. For example, if the waist pain is significant, combine with the affected side's Yaoyan point. If the buttock muscles are tense, combine with Huanjiao and Yibian points. If the posterior thigh muscles are tense, combine with Chengfu, Yinmen, and Weizhong points. If there is numbness on the lateral thigh, combine with Fengshi. For numbness in the calf, combine with Weiyang, Chengshan, Yanglingquan, Zusanli, and Xuanzhong points. If the dorsum of the foot is numb, combine with Taixi, Jiexi, and Xiexi.

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Written by Cheng Bin
Orthopedics
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What sleeping position should be used for lumbar disc herniation?

If the patient simply presents primarily with symptoms of back pain, it is advisable to lie on the back and sleep on a firm mattress. It is best to wear a lumbar support belt to protect the lumbar spine. If the patient's lumbar disc herniation is quite severe, causing sciatic nerve pain, it is better to sleep in a lateral position during sleep. When lying on the side, actively flexing the knees and hips can reduce the traction on the sciatic nerve, thereby effectively alleviating the patient's leg pain symptoms. Additionally, for patients with disc herniation, it is necessary to avoid prolonged sitting or standing, avoid excessive bending to lift heavy objects, and avoid lifting heavy items. Actively cooperating with acupuncture, electric therapy, cupping, traction, massage, and other physical therapy methods can further improve the patient’s clinical symptoms.

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Written by Na Hong Wei
Orthopedics
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What department should I see for a lumbar disc herniation?

For herniated lumbar discs, you should visit either the Department of Spine Surgery or Orthopedics. The specific department depends on the hospital you choose to visit. If the hospital is a high-level institution, grade three or above, it will certainly have a Department of Spine Surgery, so this would be the first choice. However, if the hospital is a community clinic or a second-tier hospital, it might not have a Spine Surgery department, so you would need to visit the general Orthopedics department. Although herniated lumbar discs are a common orthopedic condition and can be treated in Orthopedics, visiting a specialist in Spine Surgery can often provide more expert care as these doctors may have higher levels of experience and expertise in treatment.