1. Lumbar Disc Herniation
LIAO Hui MD
Tongji Hospital, HUST

2. Low back pain strain of the muscles ligaments and tendons
Herniation of lumbar disc
sciatica
Various other conditions

3. Spine "S"-like curve Cervical spine 7 vertebrae
Thoracic spine 12 vertebrae
Lumbar spine 5 vertebrae
Sacrum
"S"-like curve

4. Anatomy

7. Etiology of Disc Degeneration
In the normal, healthy disc, the nucleus distributes the load equally throughout the anulus
As the disc undergoes degeneration, the nucleus loses some of its cushioning ability and transmits the load unequally to the anulus
In the severely degenerated disc, the nucleus has lost all of its ability to cushion the load, which can lead to disc herniation

8. Degeneration Prolapse Extrusion Sqeuestration
A herniated disc occurs when the intervertebral disc's outer fibers (the annulus) are damaged and the soft inner material of the nucleus pulposus, under extreme pressure, bulges out through the annulus fibrosus ring. If the annulus tears near the spinal canal, the nucleus pulposus material can push into the spinal canal.

9. Causes

10. Which kind of position is right when you to lift something heavily form the ground. First squat and then stand up is the correct method.

11. Symptoms
Pain
Numbness
Muscle weakness
Loss of the reflexes

12. Signs
Skin sensation
Muscle power
Reflexes

13. SCIATICA
S1 nerve root

14. L5 nerve root

15. L4 nerve root

16. Diagnosis Complete history of the problem Physical examination.
Diagnostic tests

17. complete history Did you have an injury? Where is the pain?
Do you have any numbness? Where?
Do you have any weakness? Where?
Have you had this problem or something like it before?
Have you had any weight loss, fevers, or illnesses recently?

18. Cauda Equina Syndrome Most serious complication
Ruptured disc material may press on the nerves that control the bowels and bladder
It can cause permanent damage lead to lose the ability to control bowels and bladder
Surgery immediately is recommend

19. physical examination Motion of Spine Weakness Pain Sensory Changes
Reflex changes
Motor skills
Special signs

20. Localizing Neurologic Levels

21. straight-leg-raise test

22. diagnostic tests
X-Ray

23. X-ray

24. MRI Scan

25. Imaging of the Herniated Disc

26. Treatment Conservative Treatment Surgical Treatment
Purpose: to relieve pain and nerve root irritation
Surgical Treatment
purpose : to relieve nerve root compression from herniated disk material.

27. Conservative Treatment
Observation
Rest and physiotherapy
Orthosis or brace

28. Conservative Treatment
Pain medications
Epidural Steroid Injection (ESI)

29. Surgical Treatment
Laminotomy and Discectomy

30. Microdiscectomy

31. Endoscopic Discectomy
Many surgical procedures have been revolutionized by the use of special TV cameras. The procedure is still the same, but even smaller incisions (1/4 inch) are made to insert a special magnified TV camera into the spinal canal so that the surgeon can actually see the disc material. Through these small incisions, the camera and several other surgical instruments are inserted. Rather than look through a microscope, he watches the TV screen while he directs the specially designed instruments to remove the disc material.
The notion is that if microdiscectomy can do less damage because of a smaller incision, endoscopic discectomy could do even less damage. This surgical procedure is still evolving and is not yet widely used.
This procedure has the benefit that it does even less damage to the normal tissues around the spine during the operation. This can lead to a still faster recovery and less complications.

32. Indication progressive neurologic deficit profound neurologic deficit
cauda equina syndrome
progressive neurologic deficit
profound neurologic deficit
severe and disabling pain refractory to four to six weeks of conservative treatment

33. Rehabilitation

34. THANK YOU