Many patients who have been diagnosed with lumbar spinal stenosis or lumbar disc herniation or lumbar spondylolisthesis and who should have opted for surgery after a period of ineffective conservative treatment continue to suffer from the disease because they are afraid of surgery, and some patients even have sequelae such as lower limb numbness and limited mobility (claudication). The main reason for fear of surgery is concern about the risk of surgery and post-surgical pain. Here, experts make a brief introduction on the risks of surgery and post-surgical pain to provide some reference for your decision. First, about the risk of surgery, the first thing to explain is that any surgery is risky, which is a very recognized phrase. However, what are the risks? How big is the risk? What is their incidence? This is the most important question for everyone. In fact, the risks of lumbar spine surgery cover a wide range, which are summarized as follows: first, the risks during anesthesia; second, the risks during surgery; third, the risks after surgery; and fourth, the risks of concurrent diseases. Here I will briefly describe the most common surgical risks that patients are most concerned about. 1, anesthesia risk Any surgery must go through anesthesia. At present, the main choice of lumbar spine surgery is general anesthesia, that is, after tracheal intubation, ventilator to maintain breathing, intravenous administration of anesthetics or intravenous and tracheal inhalation (anesthetic) combined with the safety of these drugs is very good and easy to control, coupled with the current technological advances, real-time monitoring of heart and lung function and bleeding during surgery, its safety is very high. However, risks still exist, such as allergic reactions to drugs, cardiac arrhythmias and cardiac arrest, and overdose due to individual differences in sensitivity to drugs, etc. These factors are all accidental factors that cannot be prevented. There are also factors that lead to injury during the operation, such as injury to the airway, voice box, reflux of food or digestive fluid causing reflux trachea and lung injury, and finally pneumonia. The risk of anesthesia will not be discussed in detail here, but will focus on the risk of the surgical procedure. 2, the risk of surgical procedures lumbar spine disease is involved in the cauda equina or nerve root. What is the cauda equina nerve? When the human body is mature, the lowest point of the spinal cord is at the lower edge of the second lumbar vertebral body, and the following nerves emanating from the spinal cord are surrounded by the dura mater, and because these nerves are more numerous and resemble the tail of a horse, they are called the cauda equina. The cauda equina travels downward and exits the neural foramen at the corresponding segment, and the nerve root is formed by the dura before it exits the neural foramen. A herniated disc or spinal stenosis involves either the cauda equina or the nerve roots. The central type of herniation compresses mainly the cauda equina, and the nerve roots on one side are compressed when it is on one side. There are many causes of lumbar spinal stenosis, mainly lumbar disc herniation, ligamentum flavum hypertrophy, and osteophytes. The purpose of surgery is to release these compression factors. Then, there is a risk of damaging the nerve roots during the surgery. The nerve root will lose its original normal anatomy after a long period of compression, making it difficult to identify during surgery resulting in misinjury, or the nerve root must be retracted during surgery due to excessive compression of the nerve root, causing temporary or permanent dysfunction (paralysis) of the nerve root due to pulling away the already compressed nerve root during removal of the anterior compressor. Injury to a single nerve root is an incomplete palsy, with the end result being numbness and walking claudication. The longer the patient’s disease duration the more difficult surgery becomes and the greater the risk of this nerve root injury. So, just how high is the incidence of this risk? There is no universally accepted rate. The incidence is generally considered to be a few parts per thousand. It is important to note that the rate of surgical risk has little to do with individual risk, and that the 1 in 1,000 risk rate is for a population. For a surgeon doing a thousand surgeries, if the first 999 patients do not have a nerve root injury, then the first thousand patients will not necessarily have a nerve root injury. Conversely, just because the first complication occurs, it does not mean that the next 999 patients will not have complications. Other factors associated with nerve injury are the experience of the surgeon, which is also of concern. The safety of lumbar spine surgery at Shanghai Xinhua Hospital Hospital is still very good due to the large volume of surgery and experience. In addition, the most common injury is the dura, which is a dense membrane that surrounds the spinal cord and cauda equina, and is protected by the cerebrospinal fluid in which the spinal cord and nerves float. Dural injury leads to cerebrospinal fluid leakage, which is not terrible and can usually be cured, and its severity is not significant. 3, post-surgical risks The main post-surgical risk is infection, and there is a risk of infection in any surgery. The source of bacteria can be invaded into the body through the flow of air during the surgery, or through surgical instruments. At present, the orthopedic operating rooms of Shanghai Xinhua Hospital are equipped with laminar flow equipment, which can achieve an environment with almost no bacteria in the air. The equipment and technology of sterilization are very good, and the probability of such possibility of infection by air and instruments is very low. Some patients may have bacteria in their bodies before surgery, but they do not develop the disease because of the body’s resistance, and after surgery, the body’s resistance decreases and infection occurs. In short, 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 endophytic nail rod, many patients surgery to use internal fixation, currently the most widely used is the nail rod system, the purpose of nail rod fixation is to make the intervertebral body unstable after the removal of the disc is temporarily fixed, while the surgery will implant bone, implant bone is the basis of intervertebral fusion. The fusion of the nail rod will be useless, and the purpose will be achieved. If there is no fusion, the nail rod will break after a long time of stress and fatigue. 4, the risk of concurrent diseases of the lumbar spine disease patients are mostly elderly patients, elderly patients are often accompanied by systemic diseases of other organs. The most common ones are coronary heart disease, hypertension, diabetes, cardiac insufficiency, pulmonary insufficiency and osteoporosis, etc. Among them, cardiopulmonary insufficiency is the most dangerous factor affecting the surgery. The surgery itself can be very traumatic for the patient, simply because the patient is not in pain after anesthesia. This trauma can lead not only to cardiopulmonary dysfunction, but also to imbalance in the coagulation and fibrinolytic systems, as well as to water-electrolyte imbalance, all of which can lead to serious complications and even life-threatening conditions. Happily, due to the advancement of technology and increased awareness, patients with complications of other systemic diseases are mostly safe from the risky period of surgery. The establishment of the intensive care unit (ICU) has made it possible to operate on patients who were not in a position to do so, making the risk of surgery much lower.