What are the methods for diagnosing lumbar disc herniation?

Written by Na Hong Wei
Orthopedics
Updated on January 06, 2025
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The diagnostic methods for lumbar disc herniation are essentially three-dimensional; that is, clinical symptoms plus physical examination combined with auxiliary examinations. First, let's talk about clinical manifestations, which include pain, functional impairment, and local sensory abnormalities in cases of lumbar disc herniation. Second, in the physical examination of lumbar disc herniation, the intervertebral disc often shows some deformation, and the most common is a reduction or disappearance of the lumbar spine's forward physiological curvature, referred to colloquially as "flatback," where the back appears flat like a board. Other findings may include spinal scoliosis and specific tender points, usually located next to the protruding vertebrae. Percussing these tender points may induce radiating pain to the buttocks or lower limbs. Additional examinations might reveal abnormalities in the strength or sensation of lower limb muscles at different stages, as various muscles and sensory areas are affected differently. Special tests such as the straight leg raise test, femoral nerve stretch test, and neck flexion test are generally positive. The most routine auxiliary examination involves taking x-ray images, followed by CT scans, which can directly visualize the location and extent of the disc herniation. Currently, magnetic resonance imaging (MRI) is also used, which has significant advantages. MRI provides three-dimensional images, showing the sagittal, coronal, and axial planes, which helps in better assessing the condition of herniated discs. Therefore, these are the areas covered in diagnosing lumbar disc herniation.

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Written by Na Hong Wei
Orthopedics
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Lumbar disc herniation is where?

Where does lumbar disc herniation occur? Let's first discuss what a lumbar disc is. A lumbar disc is a fibrous pad located between the upper and lower vertebrae, which can be understood as a joint between the two vertebrae. Its outer layer is made up of a dense fibrous ring, formed in different combinations and arrangements, with a nucleus pulposus in the middle, which primarily functions to bear pressure from various directions and disperse it. Lumbar disc herniation occurs when, for various reasons such as aging, trauma, or pathological changes, the lumbar disc protrudes. If the protrusion does not break through the fibrous ring, it is called bulging. If it compresses and causes the fibrous ring to rupture, it is called herniation. Thus, the herniation can protrude backward, upward, or forward; however, it is mostly the backward protrusion that can cause symptoms by compressing nearby tissues, such as the spinal cord, blood vessels, and nerve roots.

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Written by Su Zhen Bo
Orthopedics
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Can a herniated lumbar disc cause leg pain?

Patients with lumbar disc herniation can experience leg pain, which is a typical clinical manifestation. After the nucleus pulposus protrudes, it can stimulate the dura mater and nerve roots, causing pain in the leg areas innervated by the nerves, or localized skin numbness, and decreased muscle strength in the lower limbs. Some patients may also experience difficulties bending over or walking normally. Additionally, some may have abnormal bowel and bladder function, and exhibit changes in reflexes like hyperactive or absent knee and Achilles reflexes. Diagnostic confirmation can be achieved through electromyography, as well as CT scans and MRI of the lumbar spine. For treatment, patients may be advised to lie flat on a hard bed, use lumbar support, and employ pelvic traction. Additionally, treatments such as massage and manipulation may be recommended.

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Written by Na Hong Wei
Orthopedics
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Is massage useful for lumbar disc herniation?

Can massage be used for lumbar disc herniation? Its clinical effects are quite good. The primary function of massage therapy is to relieve muscle spasms, then dilate blood vessels, increase local blood circulation, and promote peripheral metabolism, thereby achieving the purpose of curing diseases. It mainly uses rolling and pushing techniques, with the main acupoint being the Jiaji acupoint. Auxiliary acupoints generally include Yangguan, Yaoyangguan, Mingmen, Shenshu, Weizhong, Chengshan, and Yanglingquan, among others. Additionally, it includes two board techniques. These board techniques are very effective for minor joint disorders of the lumbar spine. There are two board techniques, one is the slant board technique, and the other is the rotating tube board technique, with the slant board technique being relatively easier to perform. Generally, patients experience varying degrees of symptom relief after proper and effective massage, and many people's symptoms disappear altogether.

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Written by Na Hong Wei
Orthopedics
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How to treat a lumbar disc herniation?

Clinically, the treatment of lumbar disc herniation usually involves the following three aspects. The first is conservative treatment, which is mainly for those patients whose lumbar disc herniation is not very severe and does not cause substantial compression of the nerve roots and spinal cord. The first step includes general treatment, that is, after developing a lumbar disc herniation, one needs to lie flat in bed, rest on a hard bed, and then rest. The second is treatment with Chinese herbal medicine, the third with Western medicine, and the fourth is traditional Chinese medicine rehabilitation treatment, which includes traction, massage, acupuncture, and others. There is also physical therapy, which includes treatments like shockwave thermotherapy and microwave therapy. Often, some patients experience symptom relief after conservative treatment. There are also some patients whose symptoms do not improve during treatment, and even worsen, at which point surgical treatment is needed. Surgical treatment has its strict indications. However, once within the range of these indications, surgical treatment should be considered. Surgical treatment now is divided into minimally invasive therapy and conventional surgical treatment. The third is other treatments, which are also numerous, including ozone therapy, sacral canal treatment, intradiscal injections, and so on. Therefore, the treatment of lumbar disc herniation mainly depends on the degree of protrusion and clinical symptoms, which are analyzed comprehensively to select a suitable treatment method.

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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.