The problems in the diagnosis and treatment of lumbar disc herniation are discussed again Lumbar disc herniation is one of the most common conditions in orthopedics, and it is also a disease with more problems in diagnosis and treatment. It has been discussed many times in the past in national academic conferences or professional journals, and it can be said that these problems are old-fashioned. However, since the problem exists, I think we should talk about it again. The current confusion in diagnosis and treatment is an indication that the discussion is not enough, or at least it is not yet widely penetrated. Sometimes it is one thing to know, but it is another thing to really know and do. For the sake of conciseness, we may as well imitate the common generalization of the society here, and summarize the “cliché” issues as: three more, and advocate what should be done as: three to do. In the diagnosis and treatment of the current more common problems: too much reliance on imaging the other day and an old Beijing orthopedic seniors chat, he said: the current orthopedic doctor outpatient back pain patients have three situations, the young doctor is only to see the film, do not see no examination “patient, middle-aged doctors are first to see the film, then see the patient, the old doctor is to see the patient first, then see the film. Although it is a joke, but also reflects the current clinicians ignore the clinical manifestations of patients and do not pay attention to the physical examination is a more common phenomenon. Excessive use of surgical treatment in order to speak with evidence: I once did a little research, in our hospital outpatient imaging report has a clear disc herniation, doctors in the medical record to give the prescription for treatment nearly 80% is surgery, whether it is the first onset or signs are not obvious. However, clinical practice tells us that most, if not most, lumbar disc herniations can be treated non-operatively. There are no less than 15 staff members in our hospital who suffer from severe lumbar disc herniation, but only a few of them receive surgical treatment, especially several of the surgeons, including general surgery, ophthalmology, gynecology, etc., who invariably refuse surgical treatment. Some of them are currently in their sixties or retired, but they are also invariably still working in the front line of surgery. The surgeon himself is reluctant to undergo surgery, so should he not also be cautious when recommending surgery to his patients? In recent years, the development of internal fixation or internal fixation has enriched the surgical treatment of lumbar disc herniation, and reasonable internal fixation can take into account the issues of decompression/stability and intervertebral height, but it is debatable whether every case of simple nucleus pulposus removal should be performed, whether cage placement, cage, and internal fixation should be used. A friend who is familiar with me asked me to look at the films of a patient with lumbar disc herniation who was operated on by a senior orthopedic surgeon. Although I do not know the clinical symptoms and signs of the patient, the MRI images showed a mild disc bulge in multiple segments of the lower back, but extensive laminectomy decompression, multi-segment cage placement and long-segment internal fixation were used, resulting in an increase in symptoms. Although this is an isolated example, the inappropriate) excessive application of internal fixation can have multiple negative effects and outcomes. The principles that should be followed in the diagnosis and treatment of lumbar disc herniation should be based on evidence (signs and symptoms). With imaging changes, there are not necessarily clinical symptoms or signs, and lumbar disc herniation with only imaging changes but no symptoms or signs generally does not require treatment. If there are imaging changes$ and lower back pain, it is not necessarily lumbar disc herniation, because there are many causes of lower back pain, it is a common symptom involving multiple diseases, if not carefully examined and carefully identified and analyzed, it is easy to ignore the main cause of pain and wrong treatment. To choose the treatment based on the pathological changes of the herniated disc there are many ways to treat lumbar disc herniation, such as various conservative treatments: Chinese medicine, western medicine, various interventional and minimally invasive surgical treatments different ways of open surgery treatment. They should not be mutually exclusive, but each has its own strengths, each has its own best indications, the correct choice of treatment should be based on the pathological changes of the herniated disc, to clarify whether it is a simple degeneration of the disc or disc bulge, if there is a herniation, to what extent it is herniated, whether there is calcification, whether it is combined with other pathological changes of the spinal canal such as hypertrophy of the ligamentum flavum, lateral saphenous fossa stenosis, to choose different treatment methods according to the different pathological changes of the disc. The practice of excluding others and trying to treat all types of disc herniation with one method is undesirable and unscientific. To “limited surgery” as the first choice of surgical treatment, reasonable and effective treatment should be based on accurate diagnosis as the premise, the so-called accurate diagnosis is to clarify the location of disc lesions, “left/right, segment: single/multiple, and pathological changes, in addition to treatment! It is more important to understand the real site of pain, 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 ‘limited surgical principles. It is inappropriate to treat most patients with lumbar disc herniation with so-called ‘radical’ or ‘prophylactic surgery,’ and making the surgery too large not only adds pain and financial burden to the patient! It is more likely to bring about the opposite effect to that expected. The above problems may not be found correctly, and the views may not be completely correct, so we would like to discuss them with our colleagues. The solution to the above problems depends on repeated in-depth discussions and mutual learning! To improve together and unify the understanding. It depends on the relevant professional societies and media under the guidance of ‘people-oriented thinking, with a sense of social responsibility as their own! Doing the correct academic guidance depends on the academic leaders of each unit to set an example and teach by example, I would like to encourage with my colleagues! To further improve the level of diagnosis and treatment of lumbar disc herniation in China and efforts.