2017-10-25

Low back pain, is it a herniated disc?

I believe that everyone has experienced low back pain, but only a few people will actively receive treatment. Once low back pain occurs, the most important thing is to seek diagnosis and treatment to relieve the symptoms and prevent recurrence.

In addition to adequate rest, you can also use conservative treatments such as drugs, physical therapy, and exercise to relieve the pain. If conservative treatment is ineffective, you can consider surgical treatment to relieve the focus.

Confirm the pain point differential diagnosis

In clinical practice, the doctor will first confirm the pain points of the patient, and distinguish whether the pain is located in the muscle distribution or the part of the sciatic nerve; then consult the doctor to determine whether the type of pain is bone headache, muscle pain, intervertebral disc pain or pain caused by nerve compression. After clinical neurological examination, understand the muscle strength, the feeling of pain, the tendon and nerve reflex, and measure the calf and leg circumference to understand whether the muscle is atrophy, so as to confirm whether the sensory nerve, motor nerve and tendon nerve reflex are normal.

If the diagnosis finds that the patient’s nerves are compressed, it is necessary to further determine which ganglion is compressed, and then evaluate the cause. If a young patient has instant unilateral pain at the same time, it may be a herniated disc; if there are symptoms such as weight loss and fever in addition to the pain, it is necessary to suspect whether there is the possibility of infection or tumor, especially diabetes or receiving chemotherapy and other immunity with less power.

After consultation and neurological testing, the patient will be asked to take X-rays to observe the shape and arrangement of the patient’s spine, whether the bones are intact, whether the intervertebral height is normal, whether there are bone spurs or osteoporosis, if the X-ray images show Consistent with clinical judgment, drugs can be given according to the needs of patients and physical therapy can be used to relieve pain.

If the patient’s lower back pain is evaluated after the examination, it is most likely that the nerve is compressed or the cause is not clear, magnetic resonance imaging (MRI) will be considered to make a clearer diagnosis.

Acute Phase

Focus on relieving inflammation and pain

After checking to determine the cause of low back pain, the doctor will give treatment according to the patient's needs. In the acute phase, patients may be unable to tolerate pain due to pain, and may not be able to sleep, work, or even affect their tolerance to pain due to poor mood. In addition, the tissue has inflammation. At this time, anti-inflammatory and analgesics can be given to relieve inflammation and pain.

Because anti-inflammatory analgesics are irritating to the stomach and intestines, most of them are clinically prescribed for only three to four weeks. In addition to alleviating pain with anti-inflammatory analgesics, patients should stay in bed as much as possible and further adjust their work or posture to reduce the pressure on the lumbar spine. Often patients have pain relief after taking anti-inflammatory analgesics, but because they have not improved their improper working posture in the past, the symptoms of back pain not only cannot be completely resolved but also increase the chance of recurrence.

In addition to drugs, appropriate physical therapy can also provide certain help to patients with low back pain. Many patients with low back pain are no strangers to pulling back traction machines, which can reduce the pressure on the spine. In the case of patients with spinal stenosis, traction can enlarge the spinal canal space and reduce the pressure on nerves and other tissues; even in patients with a herniated disc, the symptoms can be relieved due to the enlarged spinal canal space and reduced pressure.

Generally speaking, more than 90% of patients can alleviate their symptoms after medication and physical therapy, and they can even heal naturally as long as they are fully bed rest. Only a small number of medications and physical therapies are ineffective, and patients suffer unbearable continuous pain before lumbar spine surgery is necessary. Generally, the area of ​​tissue compression is wider, or the space of certain specific parts is narrower. As long as a little protrusion of the intervertebral discs will compress the nerves, this kind of situation is more likely to cause conservative treatments such as drugs and physical therapy to fail. Compressed nerves can cause serious effects, and surgery needs to be considered at this time.

Surgery can be divided into two major categories: decompression surgery and fixation surgery. In simple terms, it is to remove the tissue that compresses the nerve, including the protruding bone or intervertebral disc. If it is evaluated that the spine may be more unstable after decompression surgery, then a fixation operation is required to fix the unstable spine with bone screws or bone plates.

Decompression surgery is clinically based on microsurgery, that is, surgery is performed using an operating microscope. If it is a simple disc herniation, microsurgery can be used for decompression. The wound of microsurgery is small, only about three to five centimeters. The wound is less painful. You can get out of bed the next day or even a few hours after the operation. As long as it is performed by an experienced spinal neurosurgeon, there are few nerve damage and After-effects such as paralysis appear. After decompression surgery, if necessary, stent fixation and fusion can be applied, or a titanium alloy artificial intervertebral disc can be placed between the two vertebrae, but this practice is generally only used for patients with herniated disc and spinal instability.

Be cautious when accepting alternative therapies

In addition to formal Western medical treatment, many patients will seek assistance from traditional Chinese medicine or other therapies. Acupuncture in traditional Chinese medicine can stimulate the acupoints to have analgesic effect, and needles are used to relieve the pain of the ganglion that causes inflammation. As for chiropractor and physical therapist performing loosening surgery by hand, these treatments have the same effect.

Regardless of medication, physical therapy, surgery, or chiropractic and other common therapies, it is recommended to diagnose by a spinal neurosurgeon before receiving any treatment to rule out whether the back pain is caused by nerve compression, tumors or osteoporosis, so as to avoid aggravating the condition. Even if the symptoms can be effectively relieved, these treatments treat the symptoms but not the root cause and not a long-term solution. Many low back pains are mainly caused by degeneration. No treatment can stop the degeneration. Only exercise to increase muscle strength and softness, and then cooperate correctly. The posture reduces the back pain caused by improper force, and can effectively delay the back pain caused by degeneration.