Lumbar 4-5 disc above the three disc herniation is called high lumbar disc herniation, accounting for 1-10% of lumbar disc herniation, due to the symptoms and signs are not as obvious as L4-5, L5S1 herniation, misdiagnosis and underdiagnosis of up to 30%-40%. Pathogenesis L3, 4 nerve root from the dura divided out of the same order than the number of intervertebral discs lower, and immediately diagonally outward out of the intervertebral foramen, in the spinal canal is not adjacent to the intervertebral discs, which is different from L5, S1 nerve root adjacent to the intervertebral discs, the pain is only from the protruding material to stimulate the tension of the annulus fibrosus, the posterior longitudinal ligament and the anterior wall of the dura, such as the protruding material is larger, but also the dura is also the cauda equina nerve roots of the dura oppression of the compression of the intervertebral canal. Therefore, it is characterized by a wide range of symptoms and signs that are not serious and atypical. Clinical manifestations Upper lumbar pain, radiating pain half along the femoral nerve and upper lumbar nerve to the groin, anterior thigh, a few up to the medial calf, 1/3 along the sciatic nerve radiating, hyperalgesia area mostly in the groin, anterior thigh to the medial calf, hip extension or heel-hip test pulling the femoral nerve caused pain half, quadriceps muscle weakness, lifting the leg weak and easy to fall, knee reflexes are weakened. Regarding the straight leg raising test, since the L4 nerve root was involved in the composition of the femoral nerve and sciatic nerve respectively, and the L4 also moved forward and close to the protrusion when the straight leg was raised during the operation, both the femoral nerve pulling and the straight leg raising test could be positive. Imaging examination X-ray plain film jointed clinically visible upper lumbar interspace narrowing, the posterior longitudinal ligament can be calcified, the posterior margin of the vertebral body can be elevated sclerosis, lumbar physiological anterior convexity disappeared and degeneration. Myelography has incomplete or complete obstruction at the level of high lumbar intervertebral disc, the corresponding dural sac is compressed, and the preserved space in the epidural cavity of the spinal canal is small; CT shows that the high lumbar intervertebral disc protrudes backward, calcification, and the heaviest one can account for half of the area of the spinal canal; CTM results are the same as the above, and the MRI is better. Diagnostic points 1, upper back pain, even if there is no nerve root compression symptoms, do not rule out LDP above L3, 4. 2, L3, 4, S1 multiple nerve root compression symptoms, in addition to less double herniation, triple herniation, should be considered as a near-central type of high-level LIDP. 3, thigh extension test positive at the same time, such as combined with a positive test of the straight leg elevation, is mostly LDP above L3, 4. 4, thigh Anterior thigh pain and sensory loss, quadriceps muscle strength and knee reflexes, although the positive rate is not high, should also be considered high LIDP. 5, CT or myelography is more significant. Treatment of non-surgical treatment is generally effective, but due to the localization in the upper lumbar and lower thoracic segments is a change in the distribution of stress lines, inappropriate activities and functional exercise after treatment can cause re-stimulation and compression, often easy to repeat.