Outpatient clinic contact with many patients, has been clearly diagnosed as lumbar spinal stenosis or lumbar disc herniation, after a period of time of conservative treatment is ineffective, should have opted for surgical treatment, but because of the fear of surgery and continue to endure the torment of the disease, and even in some cases, there are residual numbness of the lower limbs and limited mobility (claudication) and other sequelae. Fear of surgery is mainly due to concerns about surgical risks and post-surgical pain. Here I would like to give a brief introduction to surgical risk and post-surgical pain to provide some reference for your decision-making. First, about the risk of surgery The first thing I would like to say is that any surgery is risky, which is a very recognized phrase. But what are the risks? What are the risks? What is the incidence rate? These are the most important questions that everyone is concerned about. In fact, the risk of lumbar spine surgery involves a wide range of aspects, which can be summarized as follows: the first is the risk during anesthesia; the second is the risk during surgery; the third is the risk after surgery; and the fourth is the risk of concurrent diseases. Below I would like to put the most common, patients are most concerned about the surgical risk briefly. 1, anesthesia risk Any surgery must go through anesthesia. At present, lumbar spine surgery mainly choose general anesthesia, that is, through the tracheal intubation, ventilator to maintain respiration, intravenous anesthetics or intravenous and tracheal inhalation (anesthesia) combined and used, the safety of these drugs is very good and easy to control, coupled with the current technological advances in the surgical process of cardiac and pulmonary function and bleeding, real-time monitoring, the safety of its very high. However, risks still exist, such as allergic reactions to the drugs, cardiac arrhythmias, cardiac arrest, overdose due to individual differences and varying sensitivity to the drugs, and so on. These are all accidental factors that cannot be prevented. In addition, there are also factors that lead to injuries during the operation, such as injuries to the airway and vocal folds, and injuries to the refluxing trachea and lungs caused by the reflux of food or digestive juices, which ultimately lead to pneumonia. I don’t want to talk about the risk of anesthesia in detail here, I want to focus on the risk of surgical process. 2. Risks of the surgical process Lumbar spine disease involves the cauda equina or nerve root. What is the cauda equina? After the human body develops and matures, the lowest point of the spinal cord is at the lower edge of the second lumbar vertebral body, and the following is encircled by the dura mater by the nerves emanating from the spinal cord, and because these nerves are more numerous and shaped like a horse’s tail, they are called cauda equina nerves. The cauda equina nerves travel downward and exit the neural foramen at the corresponding segment, and before they exit the neural foramen, they have already exited the dura mater to form nerve roots. Herniated disc or spinal stenosis involves either the cauda equina or the nerve root. The central herniation compresses mainly the cauda equina, and when it is partial to one side, it compresses the nerve root on the other side. Lumbar spinal stenosis is caused by more reasons, mainly lumbar disc herniation, hypertrophy of ligamentum flavum, nerve root canal stenosis, osteophytes and so on. The purpose of surgery is to release these compressive factors. Then, there is a risk of damaging the nerve root during the surgery. The nerve root will lose its original normal anatomical structure after a long period of compression, making it difficult to recognize and cause accidental injury during the surgery, or during the surgery due to the excessive compression of the nerve root, the nerve root that has been compressed must be pulled away when removing the compression-causing material in front of it, which will result in the pulling injury and lead to the temporary or permanent dysfunction of the nerve root (paralysis). Injury to a single nerve root is incomplete paralysis with the end result being numbness and walking claudication. The longer the duration of the patient’s disease the more difficult surgery becomes and the greater the risk of this nerve root injury. So, just how high is this risk and what is its incidence? There is no universally recognized rate. For this reason, we have conducted a statistical study in collaboration with several hospitals across the country, and the results will be published in the near future. The rate is generally considered to be a few thousandths of a percent. It should be noted that the rate of surgical risk has little to do with individual risk, and the 1 in 1,000 risk rate is for a group, so if this unfortunate event occurs, then it is 100 percent for the patient in whom it occurs. If a surgeon performs a thousand surgeries and the first 999 patients do not have nerve root injuries, then the first thousand patients will not necessarily have nerve root injuries. Conversely, just because a complication occurs in the first one does not mean that it will not occur in the next 999. Factors related to nerve injury also include the experience of the surgeon, which is also a concern. Currently, most tertiary care hospitals are still very safe due to their high volume of surgeries and experience. In addition to this, the most common injury is to the dura mater, which is a dense membrane that surrounds the spinal cord and cauda equina nerves, and is lined with cerebrospinal fluid, in which the spinal cord and nerves are protected by floating in the cerebrospinal fluid. Dural injury leads to cerebrospinal fluid leakage, cerebrospinal fluid leakage is not terrible, usually can be cured, its severity is not big. 3. Risks after surgery The main risk after surgery is infection, and there is a risk of infection in any surgery. The source of bacteria can invade the body through the flow of air during surgery or through surgical instruments. Currently, operating rooms in tertiary care hospitals are equipped with laminar flow equipment, which allows for a virtually bacteria-free air environment. Sterilization equipment and techniques are so good that the chances of such a possibility of infection from air and instruments are very low, and if there is one, there will be a mass infection event. Bacteria may also be present in the body of some patients prior to surgery, but because of the body’s resistance it does not develop, and after the surgery the body’s resistance is lowered and an infection occurs. In conclusion, the risk of infection is very low, and the treatment of infection is not very difficult, and the cure rate is very high. The other is the breakage of the internal plant nail rod, many patients surgery to use internal fixation, the most widely used is the nail rod system, the purpose of the nail rod fixation is to make the unstable intervertebral body after the discectomy temporarily fixed, and at the same time, the surgery will be implanted, bone grafting is the basis of the fusion of the intervertebral body. With fusion the nail rods are rendered useless and the goal is achieved. If there is no fusion, the nail rod will break after a long time of stress and fatigue. 4, the risk of concomitant diseases Most patients with lumbar spine disease are elderly patients, and elderly patients are often accompanied by diseases of other organs in the body at the same time. The most common are coronary heart disease, hypertension, diabetes mellitus, pulmonary heart disease, osteoporosis, etc. Among them, incomplete cardiopulmonary function is the most dangerous factor affecting the surgery. Surgery itself can be very traumatic for the patient, simply because the patient does not suffer from pain after anesthesia. This trauma not only leads to cardiopulmonary dysfunction, but also to an imbalance in the coagulation and fibrinolytic systems, as well as a water-electrolyte imbalance, all of which can lead to serious complications and even life-threatening conditions. Happily, due to technological advances and increased awareness, patients with complications from other systemic illnesses are more often than not able to safely survive the dangerous period of surgery. The establishment of intensive care unit (ICU) makes it possible for patients who are not in a position to undergo surgery to undergo surgical treatment, which greatly reduces the risk of surgery. Second, post-surgical pain Post-surgical pain is also a problem that many people worry about. In recent years, there has been a rapid development in postoperative analgesia, which mainly consists of routine oral anti-inflammatory and analgesic drugs and voluntary use of postoperative anesthesia pumps for continuous analgesia, so as to minimize postoperative pain. Therefore, postoperative pain no longer bothers patients. Third, the choice of surgery Each patient to undergo surgery to make the decision to undergo surgery is careful and prudent, is after a painful decision-making process. I believe that the way of thinking of each individual is very important in the choice of surgery. Before making a decision, the patient’s focus is different, if the patient is very concerned about the risks of surgery, then he or she will not make the decision to operate early, if the patient is more focused on the condition, focus on the harm caused by the disease, then the patient will actively request surgery. In my clinical work, I often ask patients to answer the following questions: First, your disease diagnosis is clear, are you in pain? Second, do you accept this level of pain now? Third, surgery can relieve your pain and suffering, of course, surgery also has risks, this risk, are you willing to take these risks for the elimination of your pain? In fact, the decision of surgery is mainly a dialectic of the third question. However, some people are not choosing to undergo surgical treatment because of the severity of their condition now, but rather they are worrying about whether or not they have to undergo surgical treatment because they fear the severity of their condition. If the second question is yes, it is wisest for the patient to turn to his or her doctor and make a final decision after an inpatient examination to assess the risks of surgery. The choice of surgery is an academic one, and the doctor has to make a decision before the surgery. The decision is not made by one doctor, but rather by a consensus that has been reached, while in some cases it is discussed by a number of doctors and a decision is made in the end. Of course, the decision is finally made by the head of the department or someone who can take full responsibility for the patient, while in some cases, communication with the patient is required before a decision can be made.