30-year-old lumbar disc herniation and calcification

Generally speaking, when people reach around 30 years old, they will find some problems with their waist. The most common one is lumbar disc herniation and calcification. The incidence of this condition is getting higher and higher. Every time it happens, the patient's most severe feeling is very severe tenderness during waist pressing, which may even restrict the movement of his waist and back.

1. General signs

(1) Lumbar scoliosis is a postural compensatory deformity that relieves pain. Depending on the location of the nucleus pulposus protrusion and the relationship between the nerve roots, the spine may bend toward the healthy side or the affected side. If the protrusion of the nucleus pulposus is located on the inner side of the spinal nerve root, the lumbar vertebra will bend toward the affected side because bending the spine toward the affected side can reduce the tension of the spinal nerve root. Conversely, if the protrusion is located on the outer side of the spinal nerve root, the lumbar vertebra will mostly bend toward the healthy side.

(2) Limited lumbar movement Most patients have limited lumbar movement to varying degrees, which is particularly obvious in the acute phase. Among them, the most obvious is the limitation in flexion, because the flexion position can further promote the posterior displacement of the nucleus pulposus and increase the traction on the compressed nerve roots.

(3) Tenderness, percussion pain, and sacrospinal muscle spasm The location of tenderness and percussion pain is basically consistent with the intervertebral space of the lesion, and 80% to 90% of cases are positive. The percussion pain is most obvious at the spinous process, which is caused by the vibration of the diseased area caused by percussion. The tenderness point is mainly located 1 cm beside the vertebrae, and radiating pain may occur along the sciatic nerve. About 1/3 of patients have lumbar sacrospinal muscle spasm.

2. Special signs

(1) Straight-leg raising test and strengthening test The patient lies on his back with his knee extended and the affected limb passively raised. The normal nerve root has a sliding range of 4mm, and discomfort in the popliteal fossa is felt only when the lower limb is raised to 60° to 70°. In patients with lumbar disc herniation, the nerve roots are compressed or adhered, causing the sliding degree to be reduced or eliminated. Sciatica will occur if the nerve roots are raised within 60°, which is called a positive straight leg raising test. In positive patients, the height of the affected limb is slowly lowered until the radiating pain disappears. Then the affected ankle joint is passively flexed to induce radiating pain again, which is called a positive enhancement test. Sometimes, because the nucleus pulposus is large, raising the healthy lower limb can also pull the dura mater and induce radiating pain in the sciatic nerve on the affected side.

(2) Femoral nerve traction test: The patient lies prone with the knee joint of the affected limb fully extended. The examiner raises the straightened lower limb so that the hip joint is in a hyperextended position. When hyperextension to a certain extent causes pain in the femoral nerve distribution area in the front of the thigh, it is positive. This test is mainly used to examine patients with L2-3 and L3-4 intervertebral disc herniation.