Many people have symptoms of low back pain in their lives, but they think it is muscle damage caused by sedentary or strenuous work, and they will be fine after recuperation, so they don’t pay much attention to it. Over time the lumbar pain can not be relieved, serious patients also have obvious symptoms of nerve compression, such as leg pain, leg numbness, etc., which is anxious to go to the hospital to see a doctor. After the examination, it was found that the lumbar spine was wrong, and when I heard that the doctor recommended surgery, I immediately panicked – can’t conservative treatment work? Is it really to the extent that surgery is necessary? Before we talk about treatment, let’s understand the structure of the lumbar spine. The middle of the lumbar spine is hollow and is called the spinal canal, through which the spinal cord and nerves pass; the part between the two vertebrae is called the intervertebral disc, which consists of three parts: the cartilage end plate, the fibrous ring and the nucleus pulposus. The nucleus pulposus is located in the center of the intervertebral disc, which is a water-rich, jelly-like elastin that acts as a cushion to prevent direct impact between the two bones. Surrounding the nucleus pulposus is a fibrous ring that connects the two vertebrae together and holds the nucleus pulposus firmly in the center. The cartilage endplates are located at the junction of the vertebral body and the intervertebral disc. Common lumbar spine diseases include lumbar disc herniation, lumbar spinal stenosis, lumbar spine slippage, lumbar degenerative scoliosis, discogenic lumbago, and lumbar spine fracture. The indications for whether surgery is required differ for different lumbar spine diseases. Lumbar disc herniation refers to the rupture of the fibrous ring of the intervertebral disc and the protrusion (or prolapse) of the nucleus pulposus from the ruptured area into the posterior spinal canal, resulting in irritation or compression of the adjacent spinal nerve roots, thus producing a series of symptoms such as lumbar pain, numbness and pain in one or both lower limbs. Patients should consider surgery if there is a progressive decrease in muscle strength; cauda equina syndrome (a series of neurological dysfunction due to compression of the cauda equina nerve), such as numbness of the lower limbs, difficulty in urination and defecation or even loss of control; or if the effect of strict conservative treatment is still not good and the patient cannot live normally. In addition, the recurrent pain of lumbar disc herniation, combined with spinal stenosis (spinal stenosis is often caused by ligament thickening and osteoarthrosis, and the spinal canal space becomes smaller) will aggravate the compression of nerves, and the effect of conservative treatment is often not good, and surgery is also recommended in this case. Some patients have large herniated lumbar discs, which may cause sudden nerve damage during exercise, and the herniated discs cannot return to their original position on their own, so early surgery is recommended. Lumbar spinal stenosis is a condition in which the diameter of the spinal canal becomes smaller, resulting in compression of the nerves passing through the spinal canal, causing neurological dysfunction such as back and leg pain, numbness, and intermittent claudication. If the patient’s spinal canal becomes significantly narrower, the compression of nerves affects the quality of life, and conservative treatment is not effective, surgery is recommended. Lumbar spine slippage is an abnormality (e.g., splitting) in the bony junction (isthmus) between adjacent vertebrae or degeneration of the small joint articulation, causing a particular lumbar vertebra to slip forward or backward. In order to maintain the stability of the lumbar spine, the surrounding small joints will grow to “hold” the slipped lumbar vertebrae, but these new growths will narrow the spinal canal even more, causing recurrent symptoms such as back pain and numbness in the lower extremities. This disease is difficult to be relieved by conservative treatment, and surgery should be the treatment of choice. Lumbar degenerative scoliosis is a scoliosis of the spine that occurs due to aging of the intervertebral discs and lumbar spine bony joints, resulting in inconsistent thickness of the vertebrae or discs. Patients with simple low back pain are still recommended to do strictly conservative treatment; if combined with symptoms such as numbness, pain and intermittent claudication in the lower extremities, it indicates the presence of spinal stenosis and other factors leading to nerve compression, which requires surgery to release the compression and properly correct lumbar scoliosis. Discogenic lumbago is chronic lower back pain caused by aging and inflammation of the intervertebral discs, which stimulates the pain receptors of the discs, but is not accompanied by symptoms of nerve compression, such as leg numbness. Such patients cannot sit for a long time, usually only for about 20 minutes. If sitting or straining for a long time, the pressure on the intervertebral disc will increase and the back pain will worsen. Conservative treatments such as plasters have little effect and often require surgery.