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EdrawMindGuidelines for Diagnosis, Treatment and Rehabilitation Management of Lumbar Disc Herniation
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Guidelines for Diagnosis, Treatment and Rehabilitation Management of Lumbar Disc Herniation
This is a mind map about the diagnosis, treatment and rehabilitation management guidelines for lumbar disc herniation. The main contents include: rehabilitation management of patients with lumbar disc herniation, treatment of lumbar disc herniation, classification of lumbar disc herniation, and diagnosis of lumbar disc herniation. , definition of lumbar disc herniation.
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Guidelines for Diagnosis, Treatment and Rehabilitation Management of Lumbar Disc Herniation
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Guidelines for Diagnosis, Treatment and Rehabilitation Management of Lumbar Disc Herniation
Lumbar disc herniation definition
Lumbar disc herniation refers to the local displacement of part of the lumbar disc tissue beyond the normal edge of the disc. The herniated tissue can be cartilage endplate, annulus fibrosus, nucleus pulposus, or any combination thereof, but it does not necessarily cause clinical symptoms. When the herniated lumbar intervertebral disc tissue causes clinical manifestations such as weakness, numbness, pain and dysfunction in the corresponding nerve innervation area, it is called lumbar disc herniation.
Lumbar disc herniation diagnosis
Lumbar disc herniation is a clinical diagnosis term, which refers to the pathological occurrence of intervertebral disc degeneration and injury. Localized disc herniation compresses and/or stimulates the nerve roots and cauda equina, causing symptoms such as low back pain, radicular pain, numbness and weakness in the lower limbs, radiating pain in the lower limbs, and urinary and fecal dysfunction. Relevant physical examinations include sensory tests, muscle strength tests, straight leg raising tests, etc.; imaging examinations, nerve electrophysiology and nerve root block examinations can help locate the responsible segment.
Recommendation 1: Based on the patient's medical history, symptoms, signs and imaging data, a diagnosis of lumbar disc herniation can be made when the imaging and nerve localization are consistent (recommendation strength: level 1, evidence level: high).
Classification of lumbar disc herniation
Recommendation 2: Patients with lumbar disc herniation can use MacNab classification to determine the pathological essence of the lesion, and MSU classification to evaluate the extent and location of the lesion. Classification should take into account the relationship between lumbar disc disease and nerves and nerve channels to help formulate diagnosis and treatment plans (recommendation strength: level 2, evidence level: moderate).
Lumbar disc herniation treatment
non-surgical treatment
Indications for non-surgical treatment
Recommendation 3: For patients with mild symptoms or patients who cannot undergo surgery due to individual conditions, non-surgical treatment can be adopted and changes in the condition should be closely observed (recommendation strength: level 2, evidence level: moderate).
Non-surgical treatment methods and effects
Recommendation 4: Patients with lumbar disc herniation should rest in bed during the acute phase (recommendation strength: level 1, evidence level: moderate).
Nonsteroidal anti-inflammatory drugs can relieve low back pain. The results of multiple randomized controlled studies have shown that the simple application of nonsteroidal anti-inflammatory drugs can partially relieve discogenic pain, but the effect is not obvious. The clinical guidelines of the North American Spine Society and the results of multiple high-quality clinical controlled studies show that short-term use of opioid analgesics can quickly relieve low back pain. Representative drugs include morphine, pethidine hydrochloride injection, etc., but due to their addictive nature, Clinical use should be selected with caution. Randomized controlled trial results show that glucocorticoids can effectively relieve inflammatory pain, but we should be wary of possible adverse reactions caused by long-term and large-scale use of these drugs. The American College of Physicians Clinical Practice Guidelines propose that muscle relaxants can relieve spasmodic pain in the lower back muscles in the acute or subacute phase of lumbar disc herniation. Representative drugs include chlorzoxazone, flupirtine, tizanidine, etc. Dehydrating agents can effectively relieve nerve root edema caused by lumbar disc herniation. Representative drugs include mannitol, glyceryl fructose, etc. Antidepressants can have a certain therapeutic effect on patients with chronic low back pain and sciatica, but the effect is not stable. Neurotrophic drugs are helpful in relieving the symptoms of numbness and weakness in the lower limbs caused by compression of nerve roots or spinal cord. Representative drugs include methylcobalamin and neurotropin. The "Spinal Pain Group of the Chinese Pain Branch of the Chinese Medical Association" has formulated the " "Chinese Pain Expert Consensus on Diagnosis and Treatment of Lumbar Disc Herniation" affirms the role of Neurotropin in the analgesia of lumbar disc herniation.
Recommendation 5: NSAIDs can relieve patients’ symptoms of waist and leg pain, but long-term use is not recommended. When using drugs, you should be highly vigilant about the occurrence of ulcers and bleeding, and regularly evaluate the patient’s tolerance to such drugs (Strength of Recommendation: Level 2, Evidence Level: high).
Recommendation 6: Long-term use of opioid analgesics is not recommended. If clinically necessary, attention should be paid to drug dependence caused by long-term use of the drug (recommendation strength: level 2, evidence level: high).
Recommendation 7: If there are no obvious contraindications, glucocorticoids can be used in the short term to relieve inflammatory pain, but long-term large-scale use of this drug is not recommended, and we should be alert to its possible adverse reactions (recommendation strength: level 1, evidence level: high).
Recommendation 8: Muscle relaxants can effectively relieve spasm and tension of low back muscles, and are suitable for spasmodic pain in low back muscles caused by lumbar disc herniation (recommendation strength: level 2, evidence level: moderate).
Recommendation 9: It is recommended that patients with acute lumbar disc herniation use dehydrating agents to relieve nerve root edema and improve their tolerance to traction stimulation, but the patient's blood pressure and electrolyte balance should be closely observed (Strength of Recommendation: Level 1, Level of Evidence :middle).
Recommendation 10: Routine use of antidepressants is not recommended for patients with lumbar disc herniation (Strength of Recommendation: Level 3, Level of Evidence: Moderate).
Recommendation 11: It is recommended to use neurotrophic drugs to treat low back pain caused by lumbar disc herniation, lumbar spinal stenosis, etc. (Strength of recommendation: level 1, evidence level: high).
Recommendation 12: It is recommended that patients with lumbar disc herniation receive early, individualized and targeted exercise treatment under the guidance of professional rehabilitation physicians to prevent further deterioration of the condition (recommendation strength: level 1, evidence level: high)
Recommendation 13: It is recommended that patients with lumbar disc herniation undergo traction treatment under the guidance of professional rehabilitation medicine personnel, but excessive traction weight and excessive time should be avoided (recommendation strength: level 2, evidence level: high)
Recommendation 14: Physical therapy can be used to treat lumbar disc herniation, but the efficacy varies greatly among individuals (strength of recommendation: level 2, level of evidence: moderate).
surgical treatment
Indications for surgical treatment
Recommendation 15: Patients with long medical history and ineffective conservative treatment should choose surgical treatment; patients with symptoms of nerve compression should have surgery to relieve nerve compression as soon as possible (Strength of recommendation: Level 2, Level of evidence: Moderate)
Choice of anesthesia method
Recommendation 16: General anesthesia is suitable for all types of patients with lumbar disc herniation who have no contraindications to general anesthesia. Epidural anesthesia can also be used for patients undergoing simple lumbar decompression surgery who are generally in good condition. Before anesthesia, existing motor and sensory nerve function defects need to be carefully identified and recorded to better select neuromuscular blocking drugs and administer them. Evaluate the effectiveness (strength of recommendation: level 2, evidence level: high).
Surgical methods and results
Recommendation 17: For patients with simple lumbar disc herniation, discectomy is feasible (recommendation strength: level 2, evidence level: high).
Recommendation 18: Physicians should choose appropriate minimally invasive surgical methods based on their technical proficiency and patient condition (recommendation strength: level 1, evidence level: high).
Recommendation 19: Posterior lumbar resection of herniated intervertebral disc tissue and interbody fusion are required to minimize damage to the spinal structure during the operation and maintain spinal stability. (Strength of recommendation: Level 2, Level of evidence: High).
Recommendation 20: For patients with postoperative recurrence of lumbar disc herniation or lumbar instability, it is recommended to use minimally invasive fusion technology (recommendation strength: level 1, evidence level: high).
Rehabilitation management of patients with lumbar disc herniation
Daily rehabilitation training
Recommendation 21: Patients with lumbar disc herniation should maintain daily activities within a tolerable range, but activities that increase the load on the spine, repeated bending and rotation should be avoided as much as possible (recommendation strength: level 1, evidence level: moderate).
Recommendation 22: Psychological counseling should be provided based on individual differences to improve the patient's psychological condition and help relieve pain (recommendation strength: level 1, evidence level: moderate).
Recommendation 23: It is only recommended that patients wear waist protectors when working at high intensity for a long time or when performing work that increases the load on the spine, and pay attention to regular relaxation; ergonomically designed lumbar cushions and seat cushions can be used to assist in maintaining the correct sitting posture; recommendations Patients with lumbar disc herniation use medium-firm mattresses (recommended strength: level 1, evidence, etc. Level: medium).
Recommendation 24: Patients with lumbar disc herniation can perform core muscle training under the guidance of professional rehabilitation physicians in order to enhance the stability of the lumbar spine (recommendation strength: level 1, evidence level: moderate).
Recommendation 25: Patients with lumbar disc herniation can perform physical and mental training such as lumbar home fitness exercises according to individual conditions (recommendation strength: level 2, evidence level: low).
perioperative recovery
Recommendation 26: Educate patients before surgery; carry out stepped rehabilitation training after surgery, including early breathing training, limb strength training, and professional rehabilitation evaluation (recommendation strength: level 2, evidence level: moderate).