Most patients with lumbar disc herniation can be cured after regular conservative treatment, and generally only about 20% patients need surgery. The following conditions are not suitable for surgical treatment.
(1) The symptoms of lumbar disc herniation are mild and can be obviously improved after rest. Although the course of the disease can last for a long time, it has little impact on life and work and is easy to cure.
(2) Lumbar disc herniation appeared for the first time or many times, but the pain was not very severe and it was not treated conservatively. For the first time, unless the patient has obvious symptoms of cauda equina nerve damage (that is, muscle weakness or even paralysis of lower limbs, corresponding sensory disorders and sensory abnormalities such as numbness, urinary incontinence, dysuria and other symptoms), surgery should not be performed.
(3) Patients whose general or local conditions are not suitable for surgery, such as older, poor physique, or lumbar disc herniation accompanied by extensive myofascitis, rheumatism and other symptoms.
(4) Patients with undiagnosed diagnosis, such as clinically suspected lumbar disc herniation, have atypical symptoms, and no disc herniation has been found by myelography, CT and MRI. It can be observed and treated at the same time, which is not suitable for surgery.
(5) Patients with cardiovascular and cerebrovascular diseases or diabetes, or patients with anesthesia contraindications, are not suitable for surgical treatment.
Sure, but the above situation is not absolute. Appropriate treatment should be selected under the guidance of doctors according to the specific conditions of patients.
Operating instructions:
(1) Patients with severe symptoms, which affect their life and work and are ineffective after 6 months of regular non-surgical treatment; Or severe symptoms, can not accept traction, massage and other non-surgical treatment.
(2) extensive muscle paralysis, hypoesthesia, and cauda equina nerve damage (such as hypoesthesia in the saddle area, dysfunction of urination and defecation, etc.). ) and completely or partially paraplegic. Most of these patients are central protrusion, or the fragments of nucleus pulposus come out of the spinal canal, which forms extensive compression on nerve roots and cauda equina. Surgery should be performed as soon as possible.
(3) Patients with severe intermittent claudication often have spinal canal stenosis at the same time, or patients with spinal canal stenosis shown by X-ray plain film and CT images can't be effectively treated by non-surgical treatment, so surgery should be performed as soon as possible.
(4) Patients with lumbar spondylolisthesis and spondylolisthesis should be operated to remove the diseased nucleus pulposus, and at the same time, the lateral lamina and spinous process should be fused with bone graft.
(5) For young and middle-aged patients with recurrent attacks, in order to restore their working ability as soon as possible, the indications for surgery can be appropriately relaxed. Surgical indications should be strictly controlled for the elderly and infirm patients.
Treatment:
1) radiofrequency thermocoagulation target ablation: it is to directly denature and solidify the protruding nucleus pulposus, shrink the volume and relieve the compression under the accurate positioning of C-arm X-ray machine, real-time monitoring of digital subtraction and accurate guidance of navigation system.
2) Chemolysis therapy of medullary nucleus: percutaneous injection of chymopapain or collagenase into intervertebral disc. Dissolve nucleus pulposus tissue. Eliminate the compression of nucleus pulposus on nerve roots. These drugs have complications such as allergic reaction and neuritis, especially collagenase. It should be used with caution.
3) Surgical treatment: posterior laminectomy or anterior retroperitoneal discectomy. At present, minimally invasive surgery includes: ① Microdiscectomy. Micro-incision discectomy Micro-incision discectomy adopts small incision (2.5-3 cm), high-power endoscope for operation and sufficient visual field illumination. Theoretically, the technical advantages include clearly showing the micro-anatomical structure, preserving epidural fat, fine hemostasis, less nerve root injury and less paravertebral muscle injury. In addition, it also includes obvious economic benefits brought by reducing hospitalization time. ② Percutaneous lumbar discectomy and aspiration. ③ The intervertebral disc was resected by lateral or posterior approach with special intervertebral disc endoscope instrument.