Surgical treatment of lumbar disc herniation has a history of more than 70 years, and the classical open nucleus pulposus removal has proven to have good results. Recently, an increasing number of patients with this disease are being advised to undergo discectomy + internal fixation + interbody implant fusion. Is it necessary for patients to undergo this internal fixation combined with interbody fusion with bone graft fusion? What kind of patients need this procedure? Is the procedure the same for younger and older patients? Is there any other surgical procedure other than internal fixation that can solve this problem? I. What is classical lumbar disc nucleus pulposus surgery? What is the long-term outcome? Classical lumbar disc nucleus pulposus surgery is performed by removing a portion of the bone plate (lamina) covering the upper and lower lumbar discs through a small incision (about 3-4 cm long) in the traditional lumbar spine, then removing the herniated disc nucleus pulposus that is compressing the sciatic nerve, and ending the surgery after the nerve roots have been investigated for compression. This classical procedure is aimed at patients with a purely posterior lateral herniated disc. That is, the disc herniation is still within the confines of the spinal canal. Through a large number of cases, the domestic and international literature has demonstrated that the excellent rate of this procedure is between 80% and 95%. The long-term efficacy satisfaction rate is more than 90%. Second, what are the disadvantages and postoperative recurrence rate of simple disc removal (including classical disc nucleus pulposus removal, discoscopic nucleus pulposus removal and foraminoscopic nucleus pulposus removal)? Disadvantages: The postoperative period of bed rest is slightly longer (usually about 2 weeks) and there is a possibility of recurrence. This is like a machine that has to keep running even after repair. Because it needs to be used all the time, there is still a process of fatigue and strain. The human intervertebral disc has the same characteristics. Therefore, some of the residual nucleus pulposus after simple disc removal may still protrude (recurrence), and the recurrence rate is generally considered to be between 6% and 15%. However, even if the recurrence does not reach the level of severe symptoms, conservative treatment can be continued, and conservative treatment is ineffective, so the reoperation rate is <6%-15%. Currently, classical disc nucleus pulposus removal has been gradually replaced by MED (discoscopic nucleus pulposus removal) or foraminoscopic procedures. The MED and foraminoscopic procedures account for an increasing proportion of the total number of procedures compared to conventional procedures. Both of these procedures use high-definition endoscopic systems, which, in addition to smaller incisions than classical procedures, are also less invasive but more technically challenging for the surgeon. The literature suggests that the recurrence rate is similar to that of the classical procedure. Are all patients with herniated discs suitable for simple lumbar disc nucleus pulposus removal? Due to the increasing awareness of lumbar disc herniation, it is now recognized that, like any other treatment, classical surgery is not perfect. As with the indications mentioned above, the classical procedure is primarily used for simple posterior lateral disc herniation. The type of disc herniation is different for each individual due to the different pathologies. In terms of the structure of the spinal canal, in addition to most postero-lateral herniations that compress the nerve roots in the spinal canal, there are also disc herniations that protrude outward into the intervertebral foramen to form extremely lateral disc herniations, disc herniations with severe spinal stenosis leading to cauda equina syndrome, high disc herniations (in the thoracolumbar segment: thoracic 12-lumbar 1 segment, L1-L2 segment), disc herniations with lumbar instability, giant posterior ring dissection, revision surgery requiring removal of the articular eminence joint, etc. With all of the above types, it can sometimes be difficult to perform classical, MED, or foraminoscopic surgery, with problems such as nerve damage during surgery and secondary lumbar spine damage at a later stage. At this point, the physician will recommend that the patient undergo internal fixation implant fusion or intervertebral fusion device implant fusion. What kind of disc herniation patients need internal fixation? The need for internal fixation and fusion is not yet standardized and controversial. It is generally believed that the need for internal fixation and fusion should be fully evaluated preoperatively and determined according to the patient's specific situation. Generally speaking, there are three conditions that require internal fixation: 1. Spinal instability. The purpose of nailing is to rebuild the stability of the spine. The stability of the spine should be evaluated before and after surgery. If there is spinal instability in the operated segment before surgery, or if there is no instability before surgery, but more bone must be occluded during surgery in order to remove the disc (e.g., huge disc herniation, large extent of calcification of the fibrous ring, serious adhesion of the nucleus pulposus to the nerve root, etc.), which destroys the stability of the spine, such patients may have postoperative back and leg symptoms due to spinal instability. In order to improve the surgical efficacy, internal fixation is required; 2. There is endplateitis combined with lumbago or discogenic lumbago. Pre-operative MRI sees aseptic inflammation of the endplate of the vertebral body, and this inflammation may cause low back pain in the patient, and the disc should be removed as much as possible to scrape the endplate and fuse the bone graft to eliminate the inflammation and low back pain symptoms. 3. Patients with high possibility of recurrence. Mainly older and second surgery patients. Older patients have poor intervertebral disc elasticity itself, which cannot withstand stress, and older patients have lumbar spine structure relaxation, all these factors are likely to lead to recurrence. For patients who need secondary surgery for recurrence, an important mechanism of postoperative recurrence is the secondary effect of vertebral instability after the first nucleus pulposus removal, which damages the posterior column of the spine during intervertebral disc surgery, disrupts the stress distribution of the lumbar spine after removing part of the disc tissue, and causes the lumbar spine to lose its normal stability. The intervertebral disc and end plate, internal fixation and bone graft fusion. V. Besides internal fixation, are there any other surgical methods that can solve such problems? So, besides internal fixation, are there any other surgical methods? In fact, there are certain treatment procedures for the surgical treatment of lumbar disc herniation. It also includes plasma radiofrequency treatment methods, non-fusion, power fixation, and artificial disc replacement. Plasma radiofrequency treatment is aimed at patients with less pronounced herniation; while non-fusion, power fixation, and artificial disc replacement are the current popular methods. The initial goal is to return a lumbar joint that may be causing stiffness to its joint motion with some degree of mobility, but the technology is not yet mature. In addition, the indications are narrower than for classical procedures, and they are expensive. In conclusion, internal fixation in patients with lumbar disc herniation is necessary only if it is useful, and its purpose is to rebuild the stability of the lumbar spine, to prevent disc recurrence, and to facilitate the patient's early discharge from bed to reduce complications. However, there are also the following disadvantages: high cost, sometimes poor nail position requires secondary surgery to adjust, and postoperative has a certain impact on lumbar mobility, and even accelerates the degeneration of discs in adjacent segments, etc. For the treatment of lumbar disc herniation, the purpose is: to differentiate between different age groups and aim for the best curative effect; to achieve the least trauma without affecting the curative effect; not to seek a one-step solution, that is, the so-called "radical cure"; the most suitable operation is the best one; to communicate fully with the surgeon before the operation, to understand one's The most suitable procedure is the best one.