When is internal fixation with bone graft fusion required for surgery in patients with lumbar disc herniation? There are conservative and surgical treatments for lumbar disc herniation, and for those patients with severe symptoms and ineffective conservative treatments, surgery has to be the last option. However, there are many surgical treatment options. For most simple lumbar disc herniation, only a small window needs to be opened and the nucleus pulposus can be removed to achieve the treatment purpose, which is a relatively simple operation, short operation time, little damage to the patient and low cost. However, for a small number of patients, internal fixation and fusion with bone graft are required, and there is no uniform standard and controversy whether internal fixation and fusion are required. In our opinion, the need for internal fixation and fusion should be fully evaluated preoperatively and determined according to the patient’s specific situation. Specifically, the following three conditions require internal fixation (i.e., “nailing”): 1. spinal instability. The purpose of nailing is to rebuild the stability of the spine. Pre-operative and post-operative assessment of the stability of the spine, if there is preoperative spinal instability, or preoperative instability, but in order to cut the intervertebral disc must bite too much bone, destroying the stability of the spine, such patients may have postoperative symptoms and discomfort caused by spinal instability, in order to improve the effectiveness of surgery, the need for internal fixation; 2, there is endplate inflammation combined with low back pain. Pre-operative MRI saw that the vertebral endplate has aseptic inflammation, this inflammation may cause the patient back pain, should be completely scraped disc, bone graft fusion, in order to eliminate the inflammation and back pain symptoms. 3. Patients with the possibility of recurrence. It is mainly older and second surgery patients. Older patients have poor intervertebral disc elasticity itself and cannot withstand the stress, and the lumbar spine structure is relaxed in elderly patients, all these factors may lead to recurrence. For patients who need secondary surgery for recurrence, an important mechanism of postoperative recurrence is the secondary effect of vertebral destabilization after the first nucleus pulposus removal, which damages the posterior column of the spine during the disc surgery, disrupts the stress distribution of the lumbar spine after removing part of the disc tissue, and causes the lumbar spine to lose normal stability. After two surgeries, the remaining discs are very little and cannot bear weight, so they may be herniated soon, so thorough scraping and internal fixation and bone graft fusion treatment is needed. In conclusion, internal fixation in patients with lumbar disc herniation is necessary to establish or rebuild the stability of the lumbar spine, resolve complications, prevent disc recurrence, and consolidate surgical efficacy.