disc source

Answer 1

If you want to ask about discogenic lumbago, this is a special type of lumbago.

** I. Pathogenic mechanism **
1. ** Lesions within the disc **
- When there was no disc protrusion, the inner layer of the anulus fibrosus inside the disc would tear and show an inflammation reaction. These diseases would directly stimulate the nerves distributed around the disc and cause low back pain.
2. ** Nervous Perception **
- Although the disc itself had no pain sensors, its degeneration or damage (such as rupture, dehydration, lack of nutrition, etc.) would cause the sensory nerves to grow into the disc along the rupture of the antrum. These nerves would receive an inflamed pain sensation, which would cause discomfort in the waist area.
3. ** An inflammation factor **
- In damaged or degenerated discs, a variety of pro-inflammatory molecules have been identified, such as tumor necrosis-alpha (TN F-alpha), il- 1 (I L- 1), IL -6 (I L- 6), prodigen-E2 (platinum group element 2), and nerve growth factor (NG F). However, the mechanism of inflammation is still unclear.
4. ** Overactive **
- Due to dehydration and lack of nutrition, the degeneration of the disc would reduce its elasticity and reduce the disc space, leading to structural instability, which would induce multiple adjacent stages of overactivity. Moreover, after the degeneration of the disc, the load tolerance was reduced, and it was easy to induce a variety of collagenases, which would cause pain.
5. ** Psychosocial factors **
- Psychosocial factors such as stress, anxiety, and negative emotions not only cause low back pain, but also prolong the course of low back pain from the acute stage to the chronic stage.

** 2. Clinic Manifestation **
1. ** Pain location and radiation status **
- The most common was long-term repeated chronic pain in the lower waist and lumbosacrum. Occasionally, it would radiate to the sacroilium joints, buttocks, or even lower limbs. However, lower back pain was the main cause. Unlike lumbar disc protrusion, the accompanying symptoms of lower limbs were not obvious.
2. ** The relationship between pain and posture **
- Every time the patient sat down, bent over, and other postures, the patient's time in sitting posture was shortened, and the tolerance was reduced. Usually, the time in a single sitting position was less than 20 minutes, and the symptoms could be quickly relieved after lying down.

** 3. Method of diagnosis **
1. ** Clinic symptoms and physical examination **
- Most of the patients complained of chronic and long-term lower back pain, and lower limb symptoms were uncommon. During physical examination, there was no tenderness or knocking pain in the waist, nor was there any pain in the straight leg caused by sciatic nerve traction.
2. ** Assistant Examination **
- Lumbar spine X-ray and lumbar spine CT can initially indicate the degeneration of the lumbar spine, but it is not sensitive. Lumbar spine MRI is more sensitive, and the affected segment of the disc shows low signal ("black disc") or there is a line of high signal at the back of the disc. Discography was currently the gold standard for the diagnosis of this disease, but it was difficult to operate and rarely used in clinical practice.

** 4. Treatment Method **
1. ** Conservatively treated **
- For early or uncertain cases, conservative treatment can be taken, including avoiding long-term standing strain, resting in bed, wearing waistline when the pain is severe, walking backward and forward for half an hour every day when the waist pain can be tolerated, intermittent traction, massage, medicine, physitherapy, back muscle function exercise, etc. Most mild patients can recover.
2. ** minimally invasive intervention therapy **
- These included peridura and disc oxygen therapy, annular thermocoagulation, low-temperature plasma ablations, and injection of platelet-rich plasma (PrP) into the disc. The choice should be made according to the patient's condition.
3. ** Surgery treatment **
- It is suitable for patients whose symptoms have not been significantly relieved after the above treatment.
4. ** Function Training **
- According to the patient's lumbar plain film, the patient was guided to carry out individual training of the core muscle groups such as the back muscles and abdominal muscles, which was helpful in maintaining the treatment effect and preventing relapse.

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