Human beings have recognized lumbar disc herniation for more than 200 years, as early as 1764, Contugno had described the comprehensive symptoms of lumbar disc herniation, and in 1934, Mixter, Barr reported that surgical resection of prolapsed lumbar discs had been successful and achieved good results. After that, scholars at home and abroad carried out lumbar disc removal successively, and carried out in-depth research on lumbar disc herniation. At present, this disease has been recognized by scholars at home and abroad, and it is believed that this disease is closely related to 95% of sciatica, 50% of low back pain, and can cause secondary lumbar spinal stenosis. The intervertebral disc is located between two adjacent vertebrae, there are inside and outside, outside the two parts of the composition, the external fibrous ring, composed of multiple layers of annular arrangement of fibrocartilage ring, around the nucleus pulposus, can prevent the nucleus pulposus outward protruding, the fibers are tough and elastic; the internal nucleus pulposus, is an elastic gelatinous material, there is a role in moderating the impact. Adults, degenerative changes in the intervertebral disc, the fibers in the annulus fibrosus becomes thicker, glass degeneration occurs so that the final rupture, so that the intervertebral disc loses its original elasticity, can not bear the original pressure. In excessive strain, sudden change of body position, violent movement or violent impact, the annulus fibrosus can be bulged outward, and thus the nucleus pulposus can be protruded outward through the ruptured annulus fibrosus, which is called herniated intervertebral disc. Lumbar disc herniation can be divided into: 1, lumbar disc bulging: that is, the annulus fibrosus is not completely ruptured, the nucleus pulposus protrudes from the place of rupture to compress the nerve root; 2, lumbar disc protrusion: the annulus fibrosus is ruptured, the nucleus pulposus is extruded from the rupture place and compresses the nerve root; 3, lumbar disc prolapse: the annulus fibrosus is ruptured, the nucleus pulposus is extruded from the rupture place, and then it breaks the posterior longitudinal ligament, and then it strays into the spinal canal, and then compresses the nerve root and spinal cord. Clinical manifestations (a) lumbago/radiating pain in one side of the lower limbs: lumbago often occurs before leg pain, or both at the same time; most of them have a history of trauma, and there may be no clear cause. The pain has the following characteristics: 1, radiating pain along the sciatic nerve conduction, directly to the lateral calf, dorsum of the foot or toes. 2, radiating pain, radiating pain, radiating pain, radiating pain, radiating pain, radiating pain. In the case of lumbar 3-4 interspace herniation, radiating pain to the anterior thigh is produced due to compression of the lumbar 4 nerve root. 2.All actions that increase the pressure of cerebrospinal fluid, such as coughing, sneezing and defecation, can aggravate lumbago and radiating pain. 3.Pain is aggravated during activities and relieved after rest. Bed position: most patients adopt the lateral position, and flexion of the affected limbs; individual severe cases in various positions are painful, can only bend the hip and knee kneeling in bed to relieve the symptoms. Combined with lumbar spinal stenosis, there is often intermittent claudication. (ii) Scoliosis: the main curvature is in the lower back, which is more obvious when bending forward. The direction of lateral curvature depends on the relationship between the protruding nucleus pulposus and the nerve root: if the protrusion is located in front of the nerve root, the trunk usually curves to the affected side. (C) Restricted spinal activity: the nucleus pulposus protrudes and compresses the nerve root, causing the lumbar muscle to show protective tension, which may occur unilaterally or bilaterally. Due to the tension of lumbar muscles, the physiologic lordosis of lumbar spine disappears. Spinal forward flexion and backward extension activities are restricted, and radiating pain to one side of the lower limbs can occur during forward flexion or backward extension. Restriction of lateral bending is often only on one side. (D) Lumbar pressure pain with radiating pain: there is a limited pressure point next to the spinous process on the affected side of the herniated disc, accompanied by radiating pain to the calf or foot, which is important for diagnosis. (E) Positive straight leg raising test: Due to the difference of individual’s physique, there is no standardized degree of positive test, and attention should be paid to the comparison of both sides. Generally speaking, it is considered positive if the affected side is limited in leg raising 30°-70° and feels radiating pain to the calf or foot. Sometimes, when the healthy limb is lifted and the affected leg becomes numb, it is caused by the pulling of the nerve on the affected side, which is of great value for diagnosis. (F) neurological examination: lumbar 3-4 herniation (lumbar 4 nerve root compression), there may be decreased or lost knee reflexes, decreased sensation in the inner calf. Lumbar 4-5 herniation (lumbar 5 nerve root compression), the anterolateral calf, dorsum of the foot hypesthesia, bunion dorsiflexion muscle strength is often reduced. In the case of lumbar 5-sacral 1 herniation (sacral 1 nerve root compression), there is hypesthesia in the posterior aspect of the calf and the lateral aspect of the foot, hypesthesia in the muscles of the 3rd, 4th and 5th toes, and hyporeflexia or loss of Achilles tendon reflex. If the nerve compression symptoms are severe, the affected limb may have muscle atrophy. If the herniation is large, or is central herniation, or if the fibrous ring ruptures and the nucleus pulposus fragments protrude into the spinal canal, there may be more extensive nerve root or cauda equina damage, and the numbness area on the affected side is usually more extensive, which may include the buttocks, the lateral femur, the calf, and the foot below the plane of the nucleus pulposus herniation. Central type herniation often have nerve damage symptoms in both lower limbs, but one side is more serious; attention should be paid to check the perineal sensation, there is often one side of the decrease, sometimes both sides of the decrease, there is often a loss of control of urination, wet pants, bedwetting, constipation, sexual dysfunction, and even partial or partial paralysis of the two lower limbs. Auxiliary examination: Frontal and lateral radiographs of lumbosacral vertebrae should be taken, and left and right oblique radiographs should be taken if necessary. There is often scoliosis, sometimes see the narrowing of the intervertebral space, the edge of the vertebral body lip hyperplasia. x-ray signs can not be used as a basis for the diagnosis of lumbar intervertebral disc herniation, but it can be used to exclude a number of disorders, such as lumbar spine tuberculosis, osteoarthritis, bone fracture, tumors, and vertebral spine slippage and so on. In severe cases or atypical cases, when there are difficulties in diagnosis, special examinations such as CT scanning and magnetic resonance may be considered to clarify the diagnosis and herniated parts. Patients with no obvious abnormality in the above examinations cannot completely exclude lumbar disc herniation. Differential diagnosis (a) lumbar small articular synapse joint disorder: the upper and lower articular synapses of adjacent vertebrae constitute lumbar articular synapse joints, which are synovial joints with nerve distribution. When the relationship between the upper and lower synovial joints is abnormal, pain can be produced by synovial insertion in the acute stage, and traumatic arthritis of the synovial joints can be produced in chronic cases, resulting in low back pain. This pain mostly occurs at 1.5 centimeters adjacent to the spinous processes, and may have radiating pain to the ipsilateral buttock or posterior thigh, which is easily confused with lumbar disc herniation. The radiating pain of this disease usually does not exceed the knee joint and is not accompanied by signs of nerve root damage such as decreased sensation, muscle strength and loss of reflexes. In cases where identification is difficult, 5 ml of 2% procaine can be injected near the small articular eminence of the lesion, and lumbar disc herniation can be excluded if symptoms disappear. (B) lumbar spinal stenosis: intermittent claudication is the most prominent symptom, the patient complains of walking for some distance, the lower limbs of soreness, numbness, weakness, must squat down to rest before continuing to walk. Cycling can be asymptomatic. Patients with many complaints and few physical signs are also important features. A few patients have manifestations of radicular nerve injury. Severe central stenosis can be incontinence, and the diagnosis can be further confirmed by special tests such as vertebral angiography and CT scan. (C) Lumbar spine tuberculosis: early limited lumbar spine tuberculosis can irritate the neighboring nerve roots, resulting in lumbago and radiating pain in the lower limbs. Lumbar spine tuberculosis has the systemic reaction of tuberculosis, the lumbar pain is more severe, and the destruction of vertebral body or vertebral arch root can be seen on X-ray.CT scan has a unique role in the early limited tuberculosis foci of vertebral body which cannot be shown on X-ray. (iv)Vertebral metastasis: pain is aggravated, worsened at night, patient is debilitated, primary tumor can be detected. vertebral body osteolytic destruction can be seen on X-ray flat film. (E) chordoma and cauda equina neuroma: chronic progressive disease, no intermittent improvement or self-healing phenomenon, often with urinary and fecal incontinence. Magnetic resonance imaging and myelography can be used to make a clear diagnosis. Treatment (I) Conservative treatment: (non-surgical treatment is also called conservative treatment, including medication and physical therapy) 80% to 90% of patients can be cured by non-surgical treatment, and the cost of treatment is also relatively low. 1, drug treatment: mostly use non-steroidal anti-inflammatory painkillers, such as acetaminophen, diclofenac, celecoxib and so on. 2.Physical therapy: many methods, including: massage massage, traction, three-dimensional traction, infrared irradiation, acupuncture, cupping, electro-acupuncture, intermediate-frequency electrotherapy, magnetic therapy ……. And so on and so forth. Several physical therapy methods used together, the effect is better. Massage massage (also called manipulation reset), for patients with bulging discs and mild herniation, you can use manipulation orthopedics with traction, traditional Chinese medicine localized hot packs with, but herniation is huge or disc prolapse of the patient, is not recommended for traction. (Surgery: (including: disc endoscopic minimally invasive surgery, microscopic disc nucleus pulposus removal, etc.) Surgical indications are: 1. Ineffective or recurring non-surgical treatment, with severe symptoms, affecting work and life. 2. 2.Neurological injury symptoms are obvious, extensive, and even continue to deteriorate, with disc fibrous ring completely ruptured nucleus pulposus fragments protruding into the spinal canal. 3.Central lumbar intervertebral disc herniation with urinary and fecal dysfunction. 4, Combined with obvious lumbar spinal stenosis. Surgery is performed under general anesthesia or epidural anesthesia. With the operating microscope or magnifying glass, the upper and lower parts of the affected part of the plate and ligamentum flavum are removed, the dura mater and nerve roots are gently pulled open to reveal the protruding intervertebral discs, and the protruding annulus fibrosus is removed with a long-handled knife, and a nucleus pulposus forceps are inserted into the intervertebral space to remove the remnants of degenerated nucleus pulposus tissue, and the wounds are flushed out, and the bleeding is completely stopped and then a drain is placed to close the suture. Because the surgery is performed by the laminectomy or laminectomy method, it does not affect the stability of the spine. After surgery, the patient can go down to the ground in 3-7 days, and the function can be recovered quickly, and the patient can resume light work in 2-3 months. Heavy labor should be avoided for six months after surgery. For those with lumbar spinal stenosis, in addition to nucleus pulposus removal, adequate decompression should be done according to the spinal stenosis. In order to prevent recurrence or reverse nucleus pulposus degeneration after Nucleus Pulposus Removal, and to slow down the acceleration of degeneration of neighboring segments, interspinous or intervertebral dynamic stabilization devices, such as Wallis, Dynesys, etc., can be used, and intervertebral implant fusion and fixation is needed for patients with spinal instability at the same time. Complications: Disc removal surgery for lumbar disc herniation is a long-standing procedure that has been performed for a long time, and the efficacy of the procedure is relatively certain. However, even so, during and after the operation, some complications may still occur, affecting the effect of the operation. 1, infection: is a common complication of all surgical procedures. In addition to the possible complications of surgical incision infection may also occur in the intervertebral space infection. 2, nerve injury: surgery in the epidural or intradural may damage the nerve root. Postoperative hemorrhage: emergency surgery is needed to remove nerve damage caused by intravertebral hemorrhage. 4. Adhesion and scarring: Adhesion and scarring often occurs between the nerve roots at the surgical site and the exposed portion of the dura mater after laminectomy, which may leave back pain or radicular nerve root pain. 5.Spinal instability: some patients’ postoperative leg pain disappears while lumbar pain persists, and there is obvious abnormal spinal activity when taking lumbar functional motion X-ray. 6.Injury of organs and large blood vessels: the most common is the injury of large blood vessels in the posterior abdominal wall during the posterior approach surgery. It may be accompanied by other organ injuries, such as bladder, ureter or small intestine. Of course, as long as there is strict aseptic operation, gentle and accurate surgical skills and the ability to improvise, complications can be avoided.