Small incision minimally invasive simultaneous treatment of lumbar intervertebral disc herniation combined with sacral cyst Case: The patient, female, 45 years old, came to the hospital because of “lumbosacral pain, numbness of the left lower limb with anal swelling for more than 4 months”. She had been treated with traditional Chinese medicine in an outside hospital, and the pain was so unbearable that she could not walk normally before admission. Physical examination showed that the left lower extremity was positive for straight push elevation test, positive for strengthening test, and the pinprick sensation in the left lower extremity and perineum was reduced. Post-admission MRI suggested: lumbar disc herniation (L5-S1) and sacral cyst (S1-2). After admission, we gave the patient a small incision minimally invasive surgery, only a 4cm long incision, and treated the lumbar disc herniation and sacral cyst at the same time. After the operation, the patient’s lumbosacral pain and anal distension improved significantly, and she was discharged from the hospital on the 10th day after the operation and was able to resume normal walking. Summary: 1. The patient had both a herniated disc and a sacral cyst, but this time only through the left posterior minimally invasive approach, the surgical incision was only 4cm, only part of the lower edge of the L5 plate was bitten off, and the upper edge of the S1 plate was opened up, completely preserving the spinous process, supraspinous ligament, interspinous ligament, and transverse process joints, and at the same time, dealing with both the herniated disc and cyst, so that the stability of the joints was completely protected from being destroyed, and there was no need to fixate the joint with a steel nail, so that she could go out of bed and move around in the early stage. The joint stability is completely protected and not destroyed, no need for internal fixation of steel nails, and early mobility, and the cost of surgery is greatly reduced. 2. When dealing with the intervertebral disc, it is necessary to protect the two nerve roots at the same time. Although the operating space is narrow and it is necessary to slowly loosen the adhesion to the nerve roots, the minimally invasive surgery has clean hemostasis and clear vision, so that the nerve roots can be clearly displayed and properly protected, which improves the safety of the surgery. 3. The herniated disc of this patient was sandwiched between the two nerve roots of L5S1, and the S1 nerve root was pushed cephalad by the sacral cyst, so we judged the situation by applying intraoperative electrophysiological monitoring and further protected the nerve root. Frequently asked questions: i. If there is both a herniated disc and a sacral cyst, which surgery is better? Will it increase the length of the incision? A: The decision is based on the symptoms and nerve root localization. a herniated disc with sacral cyst at L4-5 lower segment can be treated with the same incision and both lesions can be treated at the same time. Do I need to stay in bed longer after the surgery than I would for a sacral cyst? A: No, it is not necessary. Although both lesions are treated at the same time, the small incision preserves the stability of the joint, so immobilization is not necessary, so there is no need to increase the postoperative bedtime. C. What are the precautions for daily life after surgery? Do not squat deeply, do not lift heavy objects, wear lumbar support reasonably, exercise reasonably, reduce and avoid bending movements, avoid trauma to the hip from falling; it is recommended to eat reasonably to increase nutrition and control weight.