Can surgical treatment of lumbar disc herniation cure the disease once and for all?

This is the 4226th article of Da Yi Xiao Hu

Lumbar disc herniation is a common degenerative lumbar lesion. In the early stage, conservative treatment is the main treatment, including changing bad posture, strengthening back muscle training, pain relief, nerve nutrition, physical therapy, etc. If the low back and leg pain worsens, the lower limb muscle strength decreases, and the bowel and bladder dysfunction occurs, and conservative treatment cannot relieve it, surgical treatment should be considered. Many people will ask, will surgical treatment solve the problem once and for all and never recur? The answer is no. Because there are two major problems after lumbar disc herniation surgery:

(1) The recurrence of lumbar disc herniation after surgery is closely related to age, obesity, degree of degeneration, osteoporosis and other underlying diseases.

(2) Postoperative adjacent vertebral disease after lumbar disc herniation (i.e., the disc next to the original herniated segment herniates again) has become increasingly common in recent years. The main causes are instability of the adjacent lumbar vertebrae or abnormal increase in the range of motion of the adjacent intervertebral space, and often require reoperation. Let's look at the treatment experience of a patient.

Patient Yang, male, 70 years old, suffered from lumbar postoperative pain for 12 years and was admitted to the hospital for treatment after the pain worsened for 2 months. The patient underwent L45 posterior decompression, bone grafting, fusion and internal fixation in an external hospital due to lumbar disc herniation in 2010. After the operation, the patient suffered from soreness and discomfort in the lower back and back. In 2017, the low back pain symptoms worsened, accompanied by radiating pain in the lower limbs. He underwent L45 revision + L34 posterior decompression, bone grafting, fusion and internal fixation again. After the operation, the symptoms of low back pain and radiating pain in the lower limbs were significantly relieved. In June 2022, the low back pain worsened, combined with osteoporosis, and he was treated with intravenous drip of Acleda. In August of the same year, the low back pain worsened again, and the visit to an external hospital indicated that the internal fixation was loose, so he underwent revision and internal fixation surgery of the L2 to S2 segments again. After the operation, the lumbar sacral region still had repeated pain, radiating pain in the lower limbs, and difficulty walking.

After Mr. Yang was admitted to the hospital, he underwent warm acupuncture and massage techniques to promote qi and blood circulation, a small needle knife was used to loosen the adhesions of lumbar scars, and Chinese medicine baths, hot packs were applied externally, and Chinese medicine was taken internally to accelerate lymphatic return. Eventually, the lumbar pain basically disappeared, and the walking function of both lower limbs was restored. He was very satisfied with the treatment results.

Surgery for lumbar disc herniation is not a permanent solution, so it is very important to take good precautions after surgery to prevent adjacent segments of the disc from herniating again and causing clinical spondylosis. After lumbar surgery, you should avoid trauma, strenuous activities, long periods of sitting or squatting, and bending over; you should insist on exercising your back muscles; control your weight appropriately; if you experience discomfort in your waist and legs, you should have a checkup in time; you should adjust your mentality, relax and integrate into your life normally.

The patient introduced in the article had severe scar tissue at the surgical site due to the large trauma of the first three surgeries, and the internal fixation device had a large irritation to the soft tissue of the lumbar sacral region. Scars are the product of the human body's repair of trauma. In normal wound healing, the synthesis and degradation of collagen maintain a balance. Pathological scar tissue overproliferates, and patients are prone to form hard hypertrophic scars after surgery, and often feel pain. The formation of hypertrophic scars after surgery will affect lymphatic return and cause soft tissue swelling.

After such multiple surgeries, most patients are reluctant to undergo surgery again. At this time, soft tissue should be treated. And small needle knife treatment is an effective method for treating soft tissue. Small needle knife is a minimally invasive Chinese medicine technology formed under the guidance of traditional Chinese medicine theory and modern medical theories such as anatomy, physiological pathology, and modern biomechanics, which combines the advantages of Chinese medicine acupuncture needles and Western medicine scalpels. It uses tissue peeling techniques to achieve the purpose of loosening adhesions. The diameter of the needle knife is generally only 0.5~0.8mm, and the damage is very small; in addition, the needle handle and the needle blade of the needle knife are in the same plane, and the direction of the needle blade in the human body can be controlled by the needle handle. The treatment is very safe and is becoming more and more popular with patients. Postoperative scar adhesion is one of the best clinical indications for needle knife, and the needle insertion point is generally in and around the scar. The treatment principle of needle knife is mainly to cut scars, separate adhesions and contractures, and dredge blockages through closed release minimally invasive operations, thereby changing the pathological state of soft tissues, restoring the mechanical balance of soft tissues and bone joints, and eliminating symptoms.

The surgical treatment of lumbar disc herniation is not a permanent solution. After the operation, it is very important to take good precautions and use other effective treatment methods such as acupuncture.

Attached photos:

Postoperative L4/5 surgery in 2010, anteroposterior and lateral radiographs in 2017

Postoperative anteroposterior and lateral radiographs of L3/4 and L4/5 in June 2017

After surgery for L2-S2 for low back pain in August 2022, weak soft tissue coverage of the sacral spine can be seen

Author: Guanghua Hospital Affiliated to Shanghai University of Traditional Chinese Medicine

Rehabilitation Department Wang Shihui Cheng Shaodan