Revisiting the problems in the diagnosis and treatment of lumbar intervertebral disc herniation Zhang Guangpu Chinese Spinal Cord Journal, 2004, No. 6, Weng Wenshui, Department of Acupuncture and Massage, Quanzhou Orthopedic Hospital, lumbar intervertebral disc herniation is one of the most common orthopedic conditions, and is also a disease in which there are more problems in diagnosis and treatment. It has been discussed many times in national academic conferences or professional journals in the past, and it can be said that these problems are clichés. However, since the problem exists, I think it is necessary to talk about it again. The current confusion in diagnosis and treatment is an indication that the discussion is not enough, or at least has not been widely penetrated into the hearts of the people. Sometimes it is one thing to know, but another to really recognize and do. In order to simplify the text, here might as well imitate the community’s common generalization of the writing style, the “cliché” of the problem is summarized as: three more, and advocate should be done as: three to be. In the diagnosis and treatment of the more common problems: too much reliance on imaging the other day and a Beijing orthopedic old-timer gossip, he said: the current orthopedic surgeon clinic to see patients with back and leg pain there are three cases, young doctors are only look at the tablets, do not look at not checking the “patient, middle-aged doctors are the first to look at the tablets, after looking at the patient, the old doctor is the first to look at the patient, and then look at the tablets. Although it is a joke, but also reflects the current clinicians ignore the patient’s clinical manifestations and do not pay attention to the physiological examination is a more common phenomenon. Excessive use of surgical treatment in order to talk about the evidence: I once did a little investigation, in our hospital outpatient imaging report has a clear disc herniation, the doctor in the medical record to give the treatment of nearly 80% of the prescription is surgical treatment, whether it is the first time the onset of the person or signs and symptoms are not obvious. However, clinical practice tells us that most, if not the majority, of lumbar disc herniations can be treated non-surgically. There are no less than 15 staff members with severe lumbar herniated discs in our hospital, but only a few of them have received surgical treatment, especially several surgeons, including general surgeons, ophthalmologists and gynecologists, who have refused to accept surgical treatment without exception. Some of them are now over 60 years old or retired, but they are still working in the front line of surgery without exception. The surgeon himself is reluctant to undergo surgery, so should he not be cautious when advising his patients to undergo surgery? Excessive use of internal fixation has enriched the surgical treatment of lumbar disc herniation in recent years due to the development of internal fixation or internal fixation. Reasonable internal fixation can take into account decompression/stabilization and intervertebral height, etc. However, it is debatable whether every simple nucleus pulposus removal should be performed with cage insertion, and whether internal fixation is still needed when cage is used. A friend who is familiar with me asked me to look at the film of a patient with lumbar disc herniation surgically treated by a senior orthopedic surgeon, although I don’t know how the patient’s clinical signs and symptoms are, but from the MRI picture, it is a relatively simple lower lumbar multisegmental mild disc bulge, but the use of a wide range of laminectomy and decompression, multisegmental cage placement and long-segment internal fixation, and the result of the symptoms instead of an increase. Although this is an isolated case, inappropriate) excessive application of internal fixation can have multiple negative impacts and effects. Lumbar disc herniation diagnosis and treatment should follow the principle of 1 to dialectic (signs, symptoms) treatment of middle-aged and elderly people in the lower lumbar spine, such as sensitive and high-resolution CT or MRI examination, there are disc pathological changes is common. With imaging changes, there may not necessarily be clinical symptoms or signs, only imaging changes without symptoms and signs of lumbar disc herniation generally do not need treatment. There are imaging changes$ and lower back pain, but also not necessarily lumbar disc herniation, because there are many causes of lower back pain, it is a common symptom involving multidisciplinary diseases, if not carefully examined, carefully analyzed, it is easy to ignore the main causes of pain and wrong treatment should be based on the pathology of the herniated disc changes in the choice of treatment Currently there are many ways to treat herniated lumbar disc, such as a variety of conservative treatments: traditional Chinese medicine, Western medicine of various interventional and minimally invasive surgical treatment of different modalities of open surgical treatment. They should not be mutually exclusive, but each has its own strengths, and each has its own best indications. The choice of the correct treatment should be based on the pathological changes of the herniated disc, and it should be clear whether the disc is pure degeneration or bulging disc, and if it is protruding, what degree of protrusion it is, whether there is any calcification, and whether it is combined with other pathological changes of the spinal canal, such as hypertrophy of the ligamentum flavum and stenosis of the lateral saphenous fossa, and it is necessary to choose different treatment methods according to the different pathological changes of the disc, i.e., ‘one treatment for one’. According to the different pathological changes of the intervertebral disc, different treatment methods should be chosen, i.e., ‘one key opens one lock’, and it is undesirable and unscientific to exclude others and try to treat all types of herniated discs with one method. To “limited surgery” as the first choice of surgical treatment, rational and effective treatment should be based on accurate diagnosis, the so-called accurate diagnosis refers to the location of the disc lesion before treatment in addition to a clear, “left/right, segment: single/multiple, and pathologic changes, and more importantly, to understand the cause of pain. More important is to understand the real site of pain, that is, the so-called ‘responsible (site or ‘responsible disc, so that it is possible to make some of the more complex lumbar disc herniation! The patient’s pain is resolved by using the principle of ‘limited surgery’. It is inappropriate to treat most patients with lumbar herniated discs with so-called ‘radical or ‘prophylactic’ surgery, as overdoing the surgery will not only increase the pain and financial burden on the patient! It is more likely to bring about the opposite of the desired effect. The above problems may not necessarily find accurate, the point of view may not be completely correct, and would like to discuss with colleagues, the original intention of the problem is to improve the current situation, the problem can only be the first step in solving the problem. The solution to the above problem depends on repeated in-depth discussion, mutual learning! Improve together and unify the understanding. Depends on the relevant professional societies and media in the ‘people-oriented thinking under the guidance of social responsibility! Do the correct academic orientation depends on the academic leader of each unit to set an example and teach by example, I would like to share my encouragement with my colleagues! I would like to work with my colleagues to further improve the diagnosis and treatment level of lumbar disc herniation in China.