Low back pain is one of the more common symptoms of lumbar disc herniation in the clinic, its causes are more, the treatment methods are also different, inexperienced doctors can not start, so there is a “patient leg pain doctor headache” said. Lumbar disc herniation is the most common cause of back and leg pain. This disease is mostly seen in young adults, patients suffer a lot of pain, with the cauda equina nerve involvement can cause urinary and fecal dysfunction, serious cases can lead to paralysis. It has a great impact on the life and work of patients. According to medical statistics, the incidence is as high as 2%. It is commonly caused by lumbar disc herniation, lumbar spinal osteophytes, cremasteric tumors, and lumbar spinal stenosis. It is due to the presence of these factors that the crural medulla or crural nerve roots are compressed, resulting in a series of clinical symptoms. For example, low back pain, bilateral or unilateral lower limb numbness and pain, and in severe cases, compression of the cauda equina nerve and urinary and fecal disorders, mostly manifested as acute urinary retention and inability to control bowel movements. And among the many patients with low back pain, about 80% of them are mainly due to lumbar disc herniation. I. Lumbar disc herniation is the prevalent population: 1, age: lumbar disc herniation is more likely to occur in people aged 25 to 50; 2, gender: lumbar disc herniation is more common in men, the incidence of men than women; 3, body type: generally too obese or too thin people prone to lumbar disc herniation; 4, occupation: labor-intensive industrial workers are common, but the current incidence of brain workers 5, posture: poor work posture, long-term ambulatory workers and often standing salesmen, textile workers, etc. are more common; 6, living and working environment: often in a cold or humid environment are to a certain extent the conditions that trigger lumbar disc herniation; 7, from the different periods of women: prenatal, postnatal and menopause are the risk period of lumbar disc herniation in women; 8, congenital People with lumbar spine dysplasia or deformity, or even people who are too mentally stressed are prone to lumbar pain, and people who smoke may be related to the fact that coughing can cause an increase in the internal pressure of the intervertebral disc and the pressure in the spinal canal, making it easy to undergo degenerative changes. Second, the etiology and pathogenesis: 1, degenerative changes in the lumbar intervertebral disc: degeneration of the nucleus pulposus is mainly manifested as a decrease in water content and can cause small-scale pathological changes such as destabilization and loosening of the push joints due to water loss; degeneration of the fibrous ring is mainly manifested as a decrease in the degree of toughness; 2, the role of external forces: long-term repeated external forces cause minor damage to the lumbar intervertebral disc over time to aggravate the degree of degeneration; 3, the intervertebral disc The weakness of the anatomical factors: the disc gradually lacks blood circulation after adulthood and has poor repair ability. (2) trauma to the lumbar region causes protrusion of the degenerated nucleus pulposus; (3) improper posture induces protrusion of the nucleus pulposus; (4) high incidence of lumbar disc herniation in people with repeated heavy lifting, vertical vibration, and twisting occupations; (4) protrusion of the nucleus pulposus can also occur with increased abdominal pressure; (5) cold and dampness can cause small blood vessels to contract and muscle spasm to increase the pressure on the disc, which may also cause degeneration of the nucleus pulposus. (5) cold and humidity cold or humidity can cause small blood vessel contraction muscle spasm so that the pressure on the disc increases may also cause degeneration of the disc. 3. Diagnosis: 1. Low back pain with sciatica. History of lumbar trauma, chronic strain or cold and dampness, most patients have a history of chronic lumbar pain before the onset; 2, often occurs in young adults; 3, lumbar pain radiates across the knee to the buttocks and lower limbs, and the pain increases when abdominal pressure increases (such as coughing and sneezing); 4, scoliosis, loss of lumbar physiological curvature, paravertebral pressure at the lesion site, and radiates to the lower limbs, and lumbar activity is limited; 5, sensory hypersensitivity in the affected innervation area of the lower limbs 5. Sensory hypersensitivity or dullness in the affected innervated areas of the lower limbs, muscle atrophy in those with prolonged disease, positive straight leg raise or strengthening test, weakened or absent knee and Achilles tendon reflexes, and weakened toe dorsiflexion; 6. Fourth, the combination of Chinese and Western medicine five-step treatment of lumbar disc herniation: 1, complete bed rest (absolute bed rest), plus the combination of Chinese and Western medicine drug treatment The effect is to reduce the weight on the pressure of the disc, the affected area is stationary conducive to inflammation subsidence. 2, drugs + physical therapy, massage, massage, small acupuncture therapy The effect is to relax the lumbar muscle spasm to reduce the pressure on the intervertebral disc. Accumulative injury causes a slight amount of rupture and bleeding of muscle fibers or ligaments, and in the process of continuous injury and repair, scar adhesions occur between the lesioned tissue and surrounding tissues, and symptoms appear from microcirculatory disorders; acupuncture can peel and unblock various adhesions between muscles and ligaments, restore local microcirculation, and enable the diseased tissue to be repaired. 3, inpatient conservative treatment Chinese and western medicine + plus sacral canal injection, local nerve block treatment, the treatment method can be anti-synovitis via nutritional drugs, injected into the lesion site, directly in the disease site, to promote the absorption of inflammatory substances caused by herniated disc, so as to achieve the purpose of treatment, this therapy is currently the best conservative treatment method recognized at home and abroad: (1) the advantages of non-surgical therapy safe, simple (1) Advantages of non-surgical treatment: safe, simple, non-invasive, less painful for patients, effective for patients with short history and mild clinical symptoms and signs. (2) Disadvantages of non-surgical treatment The treatment effect is relatively poor, the effect is slow, the treatment is not complete, and the degree of lesion and the timing of treatment must be grasped. Before the emergence of interventional disc therapy, open surgery was the only effective means of treating severe disc herniation, and interventional therapy has introduced the concept of minimally invasive treatment for disc herniation. The currently available interventional methods include collagenase lysis, percutaneous excision and suction, laser vaporization (PLDD), plasma pulpal nucleoplasty, ozone, and radiofrequency ablation. However, the above methods are all indirect decompression, only for some cases of inclusive herniation, can not completely remove the diseased nucleus pulposus, especially the tissue compressing the nerve, can not repair the broken fiber ring, necrotic tissue needs to rely on the body’s natural absorption, long time, pain, high recurrence rate. Intervertebral foraminoscopic disc removal is currently the most advanced treatment for lumbar disc herniation in the world, and our hospital is currently one of the few hospitals in the province. The treatment method has: (1) Minimally invasive Reaching the target area through a lateral approach, avoiding interference with the spinal canal and nerves by traditional posterior surgery, without biting off the vertebral plate, without destroying the paravertebral muscles and ligaments, and without affecting the stability of the crest. (2) Direct purpose The surgical effect is consistent with microscopic discectomy, the gold standard of intervertebral disc surgery. (3) Wide indications Capable of dealing with almost all types of disc herniation, some spinal stenosis, foraminal stenosis, calcification and other bony lesions. The speculum makes scarring at the posterior important structures, causing adhesions of the spinal canal and nerves. (4) High safety Local anesthesia, which can interact with the patient during the operation, does not hurt the nerves and blood vessels; basically no bleeding, clear surgical field, greatly reducing the risk of misoperation. (5) Fast recovery The next day after surgery, the patient can go down to the floor and resume normal work and physical exercise in 3-6 weeks on average. (6) High patient satisfaction Immediate pain relief, self-care of urine and stool, simple care, oral antibiotics can be taken, and outpatient surgery is feasible; the skin incision is less than 1 cm, in line with the aesthetic point of view. 5.Open surgery is suitable for those who have a clear diagnosis of lumbar disc herniation and have been ineffective for 6 months after regular non-surgical treatment; those with severe symptoms of recurrent attacks; those with sudden lumbar disc herniation with severe radicular pain that cannot be relieved and continues to increase; those with lumbar disc herniation combined with loss of nerve root function or cauda equina nerve dysfunction: 1.Advantages Extensive exposure, complete decompression, convenient operation, for those with combined central spinal canal It is particularly suitable for lumbar disc herniation with central stenosis. 2. Disadvantages Excessive removal of the posterior structures of the crest can have a certain impact on the stability of the crest. With the development of minimally invasive technology, traditional decompression nucleus pulposus removal at our hospital is decreasing year by year, and is now mainly used for patients with severe spinal stenosis and lumbar instability to perform complete decompression and rebuild the stability of the crest.