Lumbar disc herniation refers to a disease in which the lumbar disc fibrous annulus ruptures and the nucleus pulposus tissue protrudes, irritating or compressing the nerve roots and producing back and leg pain. The pathogenesis of lumbar disc herniation is that the nucleus pulposus tissue protrudes into the spinal canal after the rupture of the lumbar intervertebral disc annulus, causing irritation or compression of the adjacent nerve roots, resulting in pain radiating to the lower extremities, or numbness and weakness of the lower extremities. Different segments of the herniated disc affect different nerve roots, and the area of pain radiation is therefore different. For example, a herniated disc at L4-5 produces pain that radiates along the buttocks, the posterior lateral thigh to the lateral calf and the dorsum of the foot. Most patients with lumbar disc herniation start with low back pain, but soon the symptoms concentrate in the legs, so leg pain is the main manifestation of lumbar disc herniation. Many people will take it for granted that lumbar disc herniation must be lumbar pain, or that lumbar pain is lumbar disc herniation. In fact, it is not true, according to statistics, 60-80% of people will experience at least one lumbar pain in their lifetime. There are many causes of low back pain, and the vast majority are not caused by a herniated disc. The pain is an inflammatory response of the nerve roots, which, although sometimes very intense, is in a relatively mild state of pathological damage. If the herniated disc continues to compress the nerve roots, it may lead to dysfunction of the nerve roots, at which point the pain may be reduced, but there will be numbness, wood, or even weakness of the lower extremities. At this time, the patient’s subjective symptoms of pain are reduced, and some patients think that their condition has improved, not knowing that numbness and weakness of the limbs are signs of nerve damage and a manifestation of disease progression. If a huge herniated disc occupies the spinal canal and compresses the cauda equina nerve, it can lead to numbness in the perineal region, effort to urinate and fecal incontinence, and weakness in the lower extremities. This is the most severe form of lumbar disc herniation and often requires emergency treatment. MRI is the most sensitive imaging modality for diagnosing lumbar disc herniation, which can not only detect the disc herniation but also see the nerve tissue, so it can determine the degree of compression of the disc on the nerve tissue. although CT can see the disc, the diagnosis is not as effective as MRI because of the poor display of the nerve tissue. Nowadays, the standard of living has improved and people are more and more concerned about their health. When back pain occurs, many people choose to go to the hospital for an MRI or CT, and such words as “bulging disc”, “herniated disc”, or even “herniated disc Compression”, “dural sac” or “nerve root”, etc. Most patients are nervous about this, but they don’t have to be. Medical science does use the terms “bulging,” “herniated,” “prolapsed,” and “free” to describe the degree of disc herniation, but these are only imaging terms. However, these are only imaging changes. The degree of herniation on imaging often does not match the patient’s symptoms. For example, many normal people with no back or leg pain at all will have a herniated disc on their lumbar spine MRI; many people with very pronounced lumbar disc herniation will have no clinical manifestations; and some people with a non-significant disc herniation will have severe leg pain. For example, in a study of 98 people with no back or leg pain at all who had a lumbar MRI, only 36% of them had normal discs; 52% had at least one bulging disc, 27% had a herniated disc, and 1% had a prolapsed disc. It has also been noted that only 4-6% of herniations can cause symptoms over the course of a person’s lifetime. Therefore, the imaging term “lumbar disc herniation” is only a phenomenon, and the disease “lumbar intervertebral herniation” is only one word away, but there is a difference. Only when the herniation is combined with radiating pain, numbness, or weakness in the lower extremities can it be called “lumbar disc herniation”, and only then is it a disease state. Most patients with lumbar disc herniation can be improved with conservative treatment. The lifetime prevalence of lumbar disc herniation requiring surgical intervention ranges from 1 to 3 percent, with 80-90 percent of patients experiencing gradual resolution of symptoms within the first 3 months of onset and not requiring surgical intervention. In general, most lumbar disc herniations, especially those disc fragments not encapsulated by the annulus fibrosus, can resorb and become smaller. Possible mechanisms include loss of water, shrinkage of inflammatory masses, and an inflammatory response mediating the removal of disc material by macrophages. Thus, so-called conservative treatment is simply symptomatic supportive therapy, both physical and pharmacological, during the process of disc shrinkage on its own. In the past, textbooks used to recommend absolute bed rest for 3 months for patients with lumbar disc herniation. However, modern evidence-based medical research has shown that prolonged bed rest does not promote symptom relief any more than short periods of bed rest and can lead to atrophy of the muscles in the low back, which is detrimental to the stability of the lumbar spine. Therefore, it is recommended that patients be bedridden for no more than 2-3 days. After that, daily life can be performed on a case-by-case basis, just by appropriately increasing the time spent in bed during the day. However, activities that increase the pressure on the disc, such as weight bearing and bending, should be avoided. Choose a comfortable mattress, not too hard or too soft (see “What kind of bed is suitable for patients with low back pain”). Stretching activities of the lumbar spine can be done to reduce muscle spasm and stiffness caused by pain and reduced lumbar activity. Activities that increase the strength of the muscles in the low back can also be done to increase the stability of the lumbar spine (see “What exercises can be done for people with low back pain”). Ultrasound, electrical stimulation and massage can reduce the symptoms of low back pain. Traction, in theory, can relieve nerve root irritation by reducing disc pressure and increasing the area of the intervertebral foramen, but the results are not reliable. Tui na orthopedics is often advertised as being able to reset a herniated disc. However, the actual situation is that when a person is standing, the internal pressure of the disc can reach 100 kg force, while the pressure in the spinal canal is close to 0. Therefore, it is impossible for the disc that has protruded into the spinal canal to return to the intervertebral space in any case. Therefore, the use of orthopedic massage as a treatment for lumbar disc herniation is quite controversial. Cases of acute exacerbation after orthopedic treatment are often seen in clinical practice. Non-steroidal anti-inflammatory drugs, such as fotarine and fenbid, are effective in reducing pain and shortening the course of the disease by reducing the inflammatory response of the nerve roots. NSAIDs should be contraindicated in patients with a history of peptic ulcer or upper gastrointestinal bleeding, and although COX-2 inhibitors (e.g., celecoxib) have a low gastrointestinal irritation response, they should also be used with caution. Patients with severe pain may also use central analgesics, dehydration, and hormones for a short period of time under medical supervision. Patients who do not respond well to oral medications can also be treated with interventional methods such as intralesional closure or nerve root sleeve closure (this operation is mostly performed by pain physicians). Many patients choose “nucleolysis” because of the poor response to medication and their reluctance to undergo surgery. “Nucleolysis is an injection of a collagenase enzyme into the intervertebral disc, which chemically lowers the pressure within the disc and causes the herniated disc to retract. However, in clinical practice, chemical damage to the nerve root is often encountered due to extravasation of collagenase. This chemical will continue to act within the intervertebral space and can lead to narrowing of the intervertebral space secondary to foraminal stenosis. Cases of intervertebral space infection resulting from manipulation are also very common. As a result, the United States, the country that invented the technology, banned the drug through the FDA as early as 1999, and the treatment disappeared one after another in the United States and in developed countries. When all these conservative treatments fail to relieve the patient’s pain, or when the patient shows signs of cauda equina damage, it is necessary to consider surgery. See “When to Choose Surgery” and “Talking About Surgery for Cervical Lumbar Spondylosis”.