Reconstruction
I. Treatment Protocols for Cervical Spondylosis (Radicular and Myelopathic Types)
(1) Radicular Cervical Spondylosis (Conservative Treatment Is the First Choice)
1. Conservative Treatment Protocol
(1) Immobilization and Rest: Avoid looking down or working with your head bent over a desk; wear a cervical collar to immobilize the cervical spine for 1–2 weeks to reduce irritation of the intervertebral discs.
(2) Medication: During the acute phase, take oral nonsteroidal anti-inflammatory drugs (NSAIDs) such as celecoxib and etoricoxib, along with neurotrophic agents (methylcobalamin and vitamin B12), combined with mannitol to reduce fluid retention and alleviate nerve root edema, pain, and numbness.
(3) Physical Therapy: Cervical traction, acupuncture, tuina massage, infrared therapy, and shockwave therapy to relieve muscle spasms and alleviate nerve root compression.
(4) Rehabilitation Exercises: Once pain subsides, perform the “米” character neck exercises, the “tuck-chin-against-the-wall” exercise, and strength training for the neck and back muscles to maintain the cervical spine’s physiological curvature.
2. Indications for Surgery
Patients for whom conservative treatment has been ineffective after 3 months, and who experience progressively worsening radiating pain and numbness in the upper extremities, accompanied by muscle atrophy and decreased muscle strength, severely affecting their work and daily life.
(II) Spinal Cord Type Cervical Spondylosis (Priority for Surgical Treatment)
This is the most severe type of cervical spondylosis. Conservative treatment can only provide temporary symptom relief; once diagnosed, early surgery is recommended to prevent irreversible spinal cord damage.
1. Surgical Procedures
Selected based on the site of compression: Anterior cervical discectomy and fusion (ACDF), anterior cervical subtotal laminectomy and fusion, or posterior cervical laminoplasty to relieve spinal cord compression and stabilize the spine.
2. Postoperative Rehabilitation
Wear a cervical collar for 1–3 months after surgery to avoid excessive flexion, extension, or rotation of the cervical spine; gradually begin muscle strength training for the limbs and balance exercises; and undergo regular follow-up imaging of the cervical spine to prevent adhesions and loosening of internal fixations.
II. Treatment Plan for Lumbar Disc Herniation
(I) Conservative Treatment (Suitable for mild to moderate herniations without muscle weakness)
1. Acute-Phase Management (1–2 weeks): Strict bed rest; avoid bending forward, prolonged sitting, and heavy lifting; immobilize the lower back; apply cold compresses locally to reduce swelling and heat compresses to relax muscles.
2. Medication: Oral anti-inflammatory and analgesic medications, neurotrophic agents, and diuretics; if necessary, perform a lumbar epidural block to rapidly relieve pain.
3. Physical Therapy: Lumbar traction, medium-frequency therapy, acupuncture, tuina massage, and cupping to relieve spasms in the lumbar and back muscles and reduce pressure on the intervertebral discs.
4. Rehabilitation Exercises: During the recovery phase, perform the “Little Swallow” exercise, five-point support, and gluteal bridge exercises to strengthen the core muscles of the lower back, maintain lumbar stability, and prevent recurrence.
(II) Surgical Treatment (Indicated for severe herniation or when conservative treatment is ineffective)
1. Indications for Surgery
Recurrent lower back and leg pain that has not responded to conservative treatment for more than 3 months; accompanied by decreased lower limb muscle strength, muscle atrophy, urinary or bowel dysfunction, or intermittent claudication.
2. Main Surgical Approaches
(1) Minimally Invasive Surgery: Endoscopic discectomy through the intervertebral foramen, which involves minimal trauma and a quick recovery; suitable for patients with simple disc protrusion or herniation.
(2) Open Surgery: Lumbar disc excision combined with intervertebral bone graft fusion and internal fixation, suitable for patients with concomitant lumbar instability, spinal stenosis, or disc calcification.
3. Postoperative Rehabilitation
Bed rest for 1 week postoperatively, followed by gradual mobilization while wearing a lumbar support; avoid bending over, lifting heavy objects, prolonged sitting, or standing for at least 1 month; gradually resume lumbar and back muscle exercises after 3 months to return to normal daily activities.
III. Treatment Options for Lumbar Spinal Stenosis
(I) Conservative Treatment
Suitable for patients with mild stenosis and mild symptoms of intermittent claudication. Treatment focuses on medication to reduce swelling and relieve pain, physical therapy to improve mobility, and lumbar and back muscle strengthening exercises. Patients should avoid prolonged sitting or walking, refrain from straining the lower back, and wear a lumbar support belt daily to protect the lumbar spine.
(2) Surgical Treatment
Indicated for severe spinal stenosis, where walking distance is less than 500 meters, lower limb numbness and pain are severe, and muscle weakness is present. The surgery centers on **spinal decompression combined with intervertebral fusion and internal fixation** to completely relieve nerve compression, correct degenerative deformities of the lumbar spine, and restore spinal stability.
