Deputy chief physician of Party Jianbo, director of interventional radiology department of Daqing Oilfield General Hospital, member of Heilongjiang Radiology Society, has been engaged in medical imaging diagnosis for more than 20 years, and has rich experience in interventional treatment of malignant tumors, uterine fibroids, cervical vertebrae, lumbar disc herniation and other diseases. (Left)
Li Qingfeng, deputy chief physician and deputy director of interventional radiology department of Daqing Oilfield General Hospital, has been engaged in medical imaging diagnosis for a long time. He is good at the diagnosis and treatment of respiratory system, digestive system, bone and joint diseases and urinary system diseases, and has rich experience in interventional treatment of cervical and lumbar disc herniation. (right)
Hello, audience friends! This is the live program of CCTV's Road to Health. Today we are going to talk about interventional therapy for lumbar disc herniation.
Moderator: What are the main treatment methods for lumbar disc herniation? How should patients choose?
Jian Jianbo: The incidence of lumbar disc herniation is very high. The key patients are in the 30-50 age group. The main symptoms are low back pain and leg pain. At present, there are many treatment methods, such as non-surgical treatment, massage, traction, physical therapy and so on. It can solve the symptoms of some patients with lumbar disc herniation, and some patients will have repeated illness. The main reason is that non-surgical methods can not solve the fundamental problem of lumbar disc herniation. Interventional therapy today is between surgical treatment and non-surgical treatment. Its advantages are not only radical cure of lumbar disc herniation, but also less trauma.
Li Qingfeng: Lumbar disc herniation is mainly due to improper exertion (improper posture). Excessive pressure on the disc will lead to swelling or prolapse of the disc, which will further compress the spinal cord and nerve roots, and then cause symptoms of low back and leg pain. The onset is very painful, and some people can't even turn over. The principle of interventional therapy is that after the puncture needle penetrates the intervertebral disc, the nucleus pulposus is removed by rotary cutting, and then decompression is carried out. After decompression, the swollen intervertebral disc and herniated nucleus pulposus can be recovered, and the symptoms will be alleviated after the compression on the nerve is alleviated. Let's look at some pictures: interventional therapy is treated in a regular operating room. An important tool for surgery is a digital silhouette machine. The doctor operates under the supervision of the screen of the X-ray machine. Before the operation, the patient lies on his side on the operating table, and the puncture site must be strictly disinfected. The operation is carried out under local anesthesia, and the patient can always stay awake. Then the casing needs to be run step by step. The last cannula, called the working cannula, has a maximum diameter of about 3.5 mm, and then it is sent to the rotary cutter for rotation through the working cannula to suck out the nucleus pulposus. In addition to this method of rotary cutting, there are laser-assisted rotary cutting methods, and the appropriate method is selected according to the specific conditions of different patients. As shown in the figure, under the monitoring of the fluorescent screen, accurate rotary cutting can be carried out after it is in place.
Moderator: What kind of patients with lumbar disc herniation is this method suitable for?
Party Jianbo: Some patients have low back and leg pain, limping or even paralysis of lower limbs. We suggest combining CT, MRI, X-ray and other imaging examinations to make a diagnosis. If the diagnosis is lumbar disc herniation, some patients who are suitable for interventional therapy can be treated with interventional therapy, and most patients are suitable for interventional therapy. This method has short operation time, about one hour, and relatively short hospitalization time. Usually you can leave the hospital in 5-7 days.
Li Qingfeng: Interventional therapy has a history of more than ten years. It has been carried out in our hospital for five years. In the past five years, nearly a thousand cases of lumbar disc herniation have been treated in our hospital. Through follow-up investigation, it was found that the success rate of operation was close to 100%, the effective rate was between 85% and 90%, and 60%-70% could return to normal life. The effect is very remarkable.
Moderator: Let's look at the situation of several patients: Patient A: "I am 70 years old this year. Before the operation, my right leg was so painful that I couldn't even put on my socks and it was hard to walk. After CT examination, it was diagnosed as lumbar disc herniation. The operation was done three years ago. There is no problem with basic activities now. "
Dang Jianbo: Our hospital gave this patient interventional therapy three years ago. Before the operation, we gave the patient a comprehensive physical examination (the patient was older). Finally, we think that the patient's physical condition can tolerate interventional therapy, and the postoperative situation is very good.
Moderator: Patient B: "I am 58 years old. I've had lumbar disc herniation for 20 years. I was very painful during my illness before the operation. I am bedridden and can't take care of myself. After examination, four intervertebral disc lesions were found, which recovered well after intervention. "
Li Qingfeng: Because the patient is an old worker, who has been engaged in manual labor for a long time, the vertebral body injury is relatively large. His family carried him to the hospital at that time. We do not advocate doing multi-segmental lesions together, but should do it in stages. If we do it together, it will have an impact on the stability of the vertebral body. Do it in stages, with a general interval of 1-2 months.
Moderator: Can interventional therapy replace surgical treatment?
Li Qingfeng: Interventional surgery does have its advantages. A large number of patients can use interventional therapy, but it is impossible to say that interventional therapy can completely replace surgery. Because some patients, such as patients with bony spinal stenosis or patients with other vertebral diseases, such as lumbar tuberculosis and tumors, are not suitable for interventional therapy, surgery must be performed.
Contraindications of interventional therapy for lumbar disc herniation
1, the intervertebral space is obviously narrow.
2. Stenosis of bony spinal canal and lateral recess
3, disc herniation with calcification
4, spondylolisthesis
It should be said that the advantages of non-surgical treatment, interventional treatment and surgical treatment are complementary, and patients should consult doctors for the best treatment plan so that patients can really benefit.
Moderator: Is it possible to relapse after interventional therapy? What problems should patients pay attention to after interventional therapy?
Wang Jianbo: Interventional therapy has the same recurrence problem as non-surgical treatment and surgical treatment. The recurrence rate is about five thousandths. Interventional therapy can be done after recurrence. If it still doesn't work, then you can only have surgery.
Li Qingfeng: The first thing to pay attention to after interventional surgery is bed rest (hard bed), which takes about a week. Patients can do some light exercise 2-8 weeks after operation, and the eighth week-the third month is the main exercise time. If you exercise well during this period, the overall effect of the operation will be revealed.
Moderator: Mr. Li from Henan is 60 years old this year. Can patients with coronary heart disease do interventional therapy for lumbar disc herniation?
Wang Jianbo: Although interventional therapy is a minimally invasive method, it still has a certain impact on the human body. We should discuss with the circulatory doctor to see if the patient's coronary heart disease is serious. If so, appropriate adjustments should be made before interventional therapy. If the condition is not serious, patients with coronary heart disease can treat lumbar disc herniation through interventional therapy. In addition, diabetic patients can do interventional therapy completely, and hypertensive patients can also do interventional therapy after their blood pressure is controlled stably.
Moderator: Mr. Hebei criminal, aged 67. I had a lumbar disc herniation operation three years ago, and now I have symptoms of low back pain. How should I treat it?
Li Qingfeng: It is recommended that patients have a CT or MRI examination first. If the patient has had interventional surgery before, he can have a second operation after recurrence. If the patient has undergone surgery before, he can be intervened after recurrence, but if the patient has undergone collagenase lysis before, he can not be intervened.
Moderator: Mr. Zhang from Shijiazhuang, 46 years old. I had symptoms of low back and leg pain more than ten years ago because of improper exertion. I did a CT scan and found out the protrusion of lumbar intervertebral disc 4-5. At that time, the symptoms were relieved after traction, but the back and leg pain recurred many years later. This year, CT diagnosed lumbar disc herniation. Can I do interventional therapy?
Dang Jianbo: Yes. If the patient does not have the above contraindications, interventional therapy can be performed.
Moderator: Mr. Huang from Beijing, 45 years old. I have intermittent low back pain for 5 months, lasting nearly 2 weeks at a time. After physical therapy or rest, my symptoms eased. Recently, because of lifting heavy objects, I got up with aggravated low back pain, accompanied by radiation pain in my right lower limb, so serious that I couldn't turn over in bed. I went to the hospital for examination, and CT showed 4-5 lumbar disc herniation. Can I do interventional therapy?
Party Jianbo: There are three kinds of disc herniation: 1, protrusion 2, protrusion 3 and bulging. If it is a bulge, there is no symptom and generally no need for interventional treatment. If there are symptoms, other diseases can be ruled out by CT and other examinations, and interventional therapy can be done.
Characteristics of interventional therapy for lumbar disc herniation
Less trauma, less pain and less complications.
Wide application range and definite curative effect.
Moderator: The telephone numbers of the hospital are (0459)5805296 and 5805056.