1, Is a herniated disc the same thing as a lumbar disc herniation? Wrong A herniated disc is when the fibrous annulus of an intervertebral disc ruptures and the nucleus pulposus tissue protrudes (or prolapses) from the rupture into the posterior or spinal canal. This is really just a pathologic change, or imaging presentation. It is not a disease. In addition there are long-term follow-up studies that have found no correlation between the presence of a herniated disc in these volunteers and the subsequent presence and duration of low back pain. Lumbar disc herniation, on the other hand, is a clinical syndrome in which a herniated lumbar disc results in irritation or compression of the adjacent spinal nerve roots, resulting in a range of symptoms such as low back pain, numbness, and pain in one or both lower extremities. The diagnostic criteria proposed by Prof. McCulloch have been used up to now: ① leg pain is greater than lumbar pain, mainly confined to the sciatic nerve or femoral nerve innervation area; ② dermatomal sensory abnormality; ③ positive straight leg raising test, the angle of which is less than 50% of the normal one, or the healthy side of the straight leg raising test is positive; ④ with two of the four items of muscular atrophy, weakness, sensory loss, and tendon reflexes; ⑤ with clinical symptoms consistent with the imaging characteristics. (5) Imaging features consistent with clinical manifestations. According to the above diagnostic criteria and the pathologic features of lumbar disc herniation, lumbar disc herniation must not only have the pathologic changes of lumbar disc herniation (imaging manifestations), but must also have the clinical manifestations of damage to the corresponding neurological structures, and pain and numbness with the characteristics of radicular distribution. Therefore, even if there is obvious lumbar disc herniation on imaging, and there is regional pain in the lumbar region, buttocks or thighs, etc., it is questionable to diagnose lumbar disc herniation if there is no pattern of radicular distribution of nerves. 2, lumbar disc herniation examination preferred CT? Wrong: MRI is better than CT in terms of diagnostic accuracy and false-positive rate, and is non-invasive, multi-dimensional and radiation-free. Therefore, for patients with a diagnosis of lumbar disc herniation and a corresponding history and positive findings on physical examination, MRI is preferred as the imaging test of choice, with CT, myelography, or CT myelography as alternatives. 3. Do I have to stay in bed for conservative treatment of lumbar disc herniation? No. Patients with acute low back pain are advised to obtain less benefit (pain, functional rehabilitation) from bed rest compared to continuing with their daily activities; and in patients with lumbar disc herniation, there is little difference in bed rest compared to remaining active. There is a large body of literature that agrees with the above, and few studies have been reported that advocate strict bed rest. It is clear that bed rest is not necessary, and if the patient’s pain and dysfunction are not so severe that it is difficult to walk, there is no need to artificially restrict his or her activities and strictly require bed rest. 4. Is enhanced myelography-guided epidural hormone injections (ESIs) necessary for the treatment of lumbar disc herniation? Yes. Compared with drug therapy, transforaminal ESI has a better utility ratio and is effective in short-term pain control, improving the clinical functional prognosis of most patients with lumbar disc herniation. Moreover, for different types of lumbar disc herniation, there is no statistically significant difference in the prognosis of ESI. 5. Is conservative treatment preferred for symptomatic lumbar disc herniation? Yes Lumbar disc herniation is self-limiting to a certain extent. For patients with mild symptoms, better functional improvement can be achieved with surgery or conservative treatment, and conservative treatment can avoid the risk of surgery for patients. For radicular pain with positive signs of nerve root compression or neurologic dysfunction, with imaging confirmation that the herniated disc matches the clinical symptoms, and with symptoms lasting longer than 6 weeks, surgery is more effective than non-surgery. It should be noted that for patients with mental depression, the functional prognosis after surgical treatment is poorer and worse. 6. Is it better to treat lumbar disc herniation surgery as early as possible? No. The longer the symptoms of lumbar disc herniation last, the worse the final treatment result will be, no matter surgical treatment or non-surgical treatment, but it has nothing to do with the duration of the disease before treatment. Surgery is recommended within 6 months for patients with lumbar disc herniated radiculopathy whose symptoms are severe enough to require surgical treatment. Available evidence suggests that patients with early surgical intervention (6 months -1 year) have faster postoperative recovery and a better long-term neurologic prognosis. Therefore, both patients and orthopedic surgeons should recognize that the treatment of lumbar disc herniation should involve early intervention, whether surgical or nonsurgical. 7. Is the efficacy of intervertebral foraminoscopy necessarily better than traditional surgery? No. For patients with strictly selected indications, intervertebral discoscopy can achieve the same results as open disc surgery. With the exception of discectomy, there is no significant difference in outcomes between percutaneous discectomy and traditional open discectomy. In addition, there is no clinical evidence that medial synovectomy for lumbar disc herniated radiculopathy improves functional prognosis. 8. Is spinal fusion necessary for specific patients with lumbar disc herniation radiculopathy? No. Only 45% of patients return to work within 1 year after fusion compared to 70% of patients who return to work within 1 year after nucleotomy. Although the results of fusion surgery are somewhat better than those of nucleotomy at 6-7 years, the difference is not significant, and fusion surgery is difficult and associated with many complications. Fusion surgery may be considered in younger patients. 9. Is the surgical outcome better in patients with a smaller herniated nucleus pulposus – fibrous ring breach? Yes. Studies with evidence level I have confirmed that what is seen intraoperatively is most closely related to the final outcome. Patients with a small herniated nucleus pulposus-fibrous annulus had the best outcome, the lowest recurrence rate (1%), and the lowest reoperation rate (1%). Patients with a herniated nucleus pulposus and intact annulus fibrosus had the next best outcome, with recurrence and reoperation rates of 10% and 5%, respectively. Patients with protruding nucleus pulposus and a large annulus fibrosus had poorer outcomes, with a recurrence rate of 27% and a reoperation rate of 21%, while patients with an unruptured nucleus pulposus and an intact annulus fibrosus had the worst outcomes. Can glucocorticoids and/or fentanyl be used after lumbar decompression surgery to improve the patient’s postoperative pain? No. For patients taking glucocorticoids and/or fentanyl, there is a significant improvement in low back pain pain in the short-term postoperative period; however, at 1 year postoperatively, there is no statistically significant difference in the degree of improvement in leg pain between patients and those who did not take glucocorticoids. Therefore, the application of glucocorticoids or/and fentanyl after lumbar decompression is not recommended to improve patients’ postoperative pain in the long term.