[Core Tips] It is often said that the spine is the source of many diseases. Indeed, some people do a day of housework, feel more tired than work. Experts warn that long-term bending, sedentary, long standing are very susceptible to lumbar disc herniation, such as computer workers, drivers, accountants, office personnel. Lumbar intervertebral discs in the age of 20 years after the gradual degeneration of aging, in some improper position, such as sitting, bending over to carry heavy objects or incorrect twisting, will lead to lumbar intervertebral discs to the rear side of the protrusion, when the compression of the spinal nerve root, it will cause acute pain and spinal root inflammation, which leads to the corresponding parts of the body pain or discomfort, the young and middle-aged people are highly prevalent. Conservative treatment must be absolute bed rest [Clinical case] Mr. Chen, 29 years old, usually healthy and likes sports. One day he was playing with his son and threw him up to catch him with his hands, when he suddenly felt severe pain in his lower back, making it difficult for him to walk. Later admitted to the hospital after X-ray and CT examination found that Mr. Chen’s lumbar disc rupture, nucleus pulposus herniation compression of the nerve. Experts recommended conservative treatment, Mr. Chen in bed for a whole month. [Expert’s explanation] Conservative treatment is non-surgical treatment, the selection of indications mainly include: the course of the disease within 3 months, the first onset of symptoms and signs are not obvious; adolescent patients; combined with serious medical diseases and patients who can not tolerate surgery. In conservative treatment, the most important thing is that the patient must be absolutely bedridden. Pain is the first symptom in patients with lumbar disc herniation, regardless of the cause. The aim of the treatment is to reduce the pressure within the disc and eliminate the pain. The pressure within the disc is greater in the sitting position and least in the lying position, so it is important to stay in bed absolutely and consider getting out of bed after the symptoms are relieved. In addition, acupuncture and physiotherapy, traction therapy for the pelvis and both lower extremities, and epidural injection therapy with steroids can be used at the patient’s discretion. Drug therapy mainly plays the role of dehydration, analgesia and nutritional nerve and auxiliary treatment. Bed rest treatment should pay attention to the requirement of lying on a hard board bed; when lying on the back, the waist needs to be padded with thin pillows, so that the trunk muscles are relaxed; to strictly adhere to the bed. Even if the symptoms allow to get out of bed, can not do lumbar flexion and extension movements; bed in bed need to insist on urination and defecation in bed, such as can not be adapted, can be assisted to urinate and defecate on the ground. Physical therapy should also pay attention to the acute sprain-induced lumbar disc herniation, after the injury should be rested for 1 to 2 days before physical therapy. Lumbar septic disease, eczema or dermatitis, with active tuberculosis, is not suitable for physical therapy. Patients with cardiac pacemaker should not use cross-frequency electrotherapy and magnetic therapy. If the symptoms worsen during physical therapy, the treatment can be suspended. Traditional surgical program emphasizes personalized treatment 【Clinical case】 Wang aunt, 55 years old, 3 years after lower lumbar spine surgery, recurrence of back pain, aggravation of 1 year, the history of recurrent low back pain for 4 years, aggravation of the left side of the back and leg pain for 3 days, and then lumbar spine slipped under general anesthesia, decompression and implantation of bone internal fixation, cured and discharged from the hospital. Why are middle-aged and elderly people prone to lumbar and leg diseases? This is a symptom of degenerative disease. With the increase of age, the spine is prone to aging (degeneration), prone to hypertrophic spondylitis, cervical and lumbar spine instability, geriatric hunchback deformity, etc., can appear cervical and lumbar spine pain. The use of step therapy for patients with lumbar disc herniation has reached a consensus in the academic community. For patients who meet the indications for surgery, such as those who are ineffective in systematic conservative treatment for more than 3 months; those who continue to be treated for lumbar and leg pain for more than 1 week without pain relief; those who have typical symptoms, signs and imaging changes; those whose condition seriously affects their work and life; and those who are requested by the patients themselves, individualized treatment plans can be selected according to the patient’s situation. Traditional methods mainly include open window, half or full laminectomy and decompression to remove the nucleus pulposus. For those with concomitant lumbar instability or severe spinal stenosis, extended decompression is required. For those with greater than 2/3 resection of the synchondrosis, treatment with internal fixation and implant fusion should be considered. In addition, there are artificial lumbar disc replacement and nucleus pulposus replacement, after more than 10 years of clinical efficacy observation, lumbar disc replacement of most of the vertebral joints appeared ossification phenomenon, so the use of this method in the lumbar spine has a downward trend. “Intervertebral foramenoscopy technology is being promoted and developed 【Clinical case】 Ms. Shi, 48 years old, was admitted to the hospital with lumbar pain combined with pain in the right lower limb for 2 years, and her condition worsened later. She was diagnosed with lumbar disc herniation, and was advised to use traditional open surgery in many hospitals, but the patient was unwilling to accept it and went to the Provincial People’s Hospital, where she was treated with local anesthesia intervertebral foraminoscopy nucleus pulposus removal + radiofrequency ablation, and the pain was relieved after the surgery, and the patient got out of the bed three days later and was discharged from the hospital after a week of recovery. [Expert’s explanation] Minimally invasive surgical treatment mainly includes injection of drugs to dissolve the nucleus pulposus (lysozyme, etc.) and percutaneous puncture disc surgery. Percutaneous puncture disc surgery is currently used more, there are mainly disc cut suction, ozone, plasma, laser, radio frequency ablation and other treatments, as well as lumbar back endoscopic removal of lumbar intervertebral disc nucleus pulposus (MED) surgery. The emergence of “intervertebral foramenoscopy technology” at the beginning of the 21st century has pushed the minimally invasive treatment of herniated disc to a completely new level, which is superior to the previous ozone and collagenase dissolution, and is currently the most minimally invasive, safest, and most economical technology. At present, this procedure has become the leading surgical method for treating spinal diseases abroad; domestically, it has been commonly carried out and rapidly developed in Beijing, Shanghai and Guangzhou. The advantages of minimally invasive technique are small trauma, less bleeding, fast recovery and easy acceptance by patients. However, it is constrained by the following factors: equipment is expensive and not every hospital can purchase it; the choice of operation is difficult; skilled operators are required; and it is a limited operation. For the long duration of the disease, the nerve root scar adhesion is serious, and at the same time combined with lumbar spine (true) slipped or vertebral body posterior edge of the severity of the stenosis caused by the combination of the vertebral canal, should not choose minimally invasive surgery, otherwise its efficacy will be affected. How can postoperative patients prevent recurrence? First of all, it is necessary to consult a specialist to choose a personalized treatment plan. For patients with lumbar instability, the removal of the protruding nucleus pulposus should be accompanied by posterior internal fixation and bone graft fusion in order to achieve a satisfactory therapeutic effect.