Lumbar disc herniation is not the most serious disease in spine surgery. However, it is of great concern to the majority of patients with lumbar herniation due to its high incidence and impact on one’s quality of life and work. There are many clinical treatments for lumbar disc herniation, and different doctors may give very different treatments and recommendations, while many patients lack the relevant knowledge and are uncertain or even anxious about surgical versus non-surgical, minimally invasive versus open surgery. The simple answer to the question of whether surgical treatment is needed after a lumbar disc herniation is that non-invasive and minimally invasive treatment is the first choice for any disease, and open surgical treatment is the last to be considered. Therefore, if the symptoms of lumbar disc herniation are severe and conservative and other treatments are ineffective, minimally invasive surgery can be considered. Otherwise, continue conservative treatment. There are few patients who need open fusion for lumbar disc herniation alone. There are roughly 3 conditions as to whether or not surgery is required for lumbar disc herniation. The first case is a necessary surgery: the disease is not a malignant disease and will not involve the patient’s life safety, but it will produce severe pain symptoms, and in some cases even seriously affect the patient’s quality of life, work status and psychological state. This is mainly the case for patients who have damaged the cauda equina nerve or have developed weakness symptoms. The second condition is debatable surgery: the disease is often effectively treated conservatively, therefore, its preferred treatment is conservative treatment, but not all patients conservative treatment is effective, so after conservative treatment is ineffective, or conservative treatment is effective but the clinical symptoms recurring patients need to consider surgical treatment. The third situation is that surgery is not needed: the clinical manifestations of the disease are light and heavy, if the symptoms can be tolerated and can maintain normal work and life, do not receive surgical treatment, to know that surgery is risky, conservative treatment, interventional treatment and other methods for lumbar disc herniation are effective and can be chosen at your discretion. If a patient asks me whether to operate for this problem of lumbar disc herniation, my reply is, first of all, I am not a fortune teller, I must fully understand your general condition, such as: medical history, symptoms, signs, imaging data, and the imaging data is preferably complete with three certificates (X-ray, CT, MRI), then the doctor can provide treatment recommendations based on professional knowledge. The conventional recommendations are: In the first case, resolutely do surgical treatment, lest the clinical symptoms are not recoverable. In the second case, try to choose a less invasive treatment method. In the third case, resolutely refrain from surgery. The choice of surgery is influenced by many factors, mainly three aspects: 1, patient side: such as the patient’s age, gender, race, height, weight, occupation, education, family situation, medical history, severity of signs, stage of the disease, other comorbidities, feedback from surrounding patients on treatment results, etc., are all factors that influence their choice of whether to operate or not. 2. Physician: For the same patient, the treatment plan may differ between older doctors and younger doctors, doctors in different levels of hospitals, and doctors from different countries due to the different degrees of knowledge of the doctors. 3. Social aspects: mainly influenced by social factors such as the patient’s medical insurance reimbursement ratio. Under the complex influencing factors, how can patients make a reasonable choice? 1.Gathering information. The process of illness is a learning process. We are in an era of knowledge explosion, and everyone can retrieve basic information about the relevant diseases very easily. The age of innovation offers many ways to solve a difficult problem, and the Internet offers the possibility for patients to obtain information. Nowadays, although patients will not treat themselves, a full understanding of the basics of the disease, natural regression, the efficacy and excellent pros and cons of various treatment methods will help to find the right treatment method, avoid detours in treatment and obtain early recovery. 2.Preferred choice. Any good treatment method needs a specific performer. It is important to find out the experience of the specific executor and the number of implementations for reference. The big hospitals have a good history of inheritance and much good education and communication opportunities, so you can’t usually go wrong trusting the local big hospitals. Between conservative and surgical treatments for lumbar disc herniation, many interventional treatments have emerged. These methods are relatively simple, easy to master, and have no serious consequences even if the treatment is not effective. Therefore, they are sought after by many small and medium-sized hospitals, as well as by interventionalists and pain physicians. However, for the nascent interventional and other techniques to accept good value for money and low risk, the expectations for efficacy should not be too high, their excellent rate is generally between 40-80%. Some patients have done some primary treatment, the effect is not good. Then produced the words of complaint, indicating that they do not understand the efficacy of treatment and the nature of the disease. 3.Screening information. After the patient gets a lot of information, how to take it is very skillful. Word of mouth among patients is the first, word of mouth in academia is the second, and advertising information is the third. The first two can be understood, is the advertisement credible? The answer is that it requires careful screening. The broad concept of any medical information dissemination, scientific knowledge, professional articles, TV programs, etc., can be understood as advertising in the broad sense, and the narrow concept is limited to paid information dissemination. Information dissemination is not wrong, now the information is overwhelming, mixed with pearls, you can not just listen to one side of the advertising, patients should look at the real information, or false information, can not rely only on advertising information to decide the treatment plan of their disease. 4.Step treatment. It is impossible to have just one treatment for any disease. Lumbar disc herniation is also, from conservative treatment, interventional treatment, minimally invasive treatment, and finally open ultimate surgery and so on many methods. In principle, different treatment methods are used at different stages. It is generally not advocated to apply the ultimate fusion fixation method in the early stages of the disease. The choice of the department is the same, early mild selection of rehabilitation, physical therapy, then invasive treatment of interventional, pain, and later minimally invasive treatment of spinal surgery. The same applies to the choice of hospital, starting with the hospital of choice, followed by the secondary hospital for interventional treatment, and then the tertiary hospital when the disease is very severe. Of course, a specialist hospital that includes all treatments is also a good choice. In general, there are several levels of doctors who treat lumbar disc herniation: conservative treatment, interventional treatment, minimally invasive treatment, and open treatment. People should not generalize: doctors say how to how, as a result, there are many kinds of statements for one disease, making it impossible for them to choose. You can choose your doctor at a level and see what people’s opinions are in order to represent the general doctor’s recommendations. Especially if it happens in the second case, it is more important to collect the advice of a level doctor. 5, end of mind. After understanding the nature of the disease, a proper mindset helps to cooperate with the doctor to successfully complete the entire process of treatment. The process of seeking medical advice should avoid two kinds of mentality, the first completely indifferent, such a person if the treatment hospital or doctor is not chosen correctly, it is easy to produce overkill, over treatment, the process and consequences of being at the mercy of others. The second type is highly allergic, such people are prone to haphazardness and less receptive to other people’s treatment suggestions. The process of treatment may be tortuous and long, and once it does not go well it is easy to produce clinical symptoms such as anxiety, leading to snowballing consequences. That is why it is said that when a person is sick, fate is left to God and the body is left to the doctor, and some things do not depend on human will. Whether in China or the United States, the process of leaving it to the doctor has to be done with eyes open and with the right person. And then a good physical and psychological process of bearing the results of adverse treatment outcomes that happen to you. For example, the preoperative account, excellent rate of 90%, the incidence of return rate is 2-3%, the overall proportion has been very low. 6, choose a doctor. Patient visit is a comprehensive process including diagnosis and treatment. It integrates a variety of test results, the patient’s condition, the doctor’s judgment and treatment process. The previous preliminary examination is the basis, the doctor’s diagnosis determines the direction of treatment. The direction is more important than the speed, which illustrates the importance of diagnosis. And the most important execution, this prodromal is the doctor’s treatment operation or process. Therefore, what hospital is second and which doctor treatment is first is the most important. A qualified doctor should have a good educational background, a good practice process, a lot of experience and the ability to deal with problems. During the treatment of a disease, various complications may arise that need to be dealt with and it is vital to choose a doctor you trust. The system of a country determines the distribution of doctors. In our predominantly public countries, doctors in large hospitals have a good education and training process, and by choosing a large hospital you are choosing a high probability of success. In Western countries where private ownership is predominant, many doctors who become famous choose to practice on their own. Private hospitals provide a high level of quality, efficient medical care, but of course charge expensive fees. Public hospital hospitals guarantee medical education while mainly guaranteeing primary care. 7.Adapt to society. Each country has its own national conditions, different countries have different medical systems, the process of seeing a doctor is different. As a human being, there is nothing more important than your own body, and how to care for your body is not too much. Take lumbar disc herniation as an example, is it difficult to see this disease in China? It is neither difficult nor difficult. Is it expensive to see a doctor? No. It is not expensive either. Compared to private hospitals in the United States, it is not so difficult and expensive for our people to see a doctor. Most patients in our country already have different kinds of health insurance. Our lumbar disc herniation treatment and that of the U.S. have their own characteristics. First, the waiting time for patients in our country is not as long as the waiting time for health insurance in the U.S., but our treatment sessions are more chaotic. In the U.S., patients need multiple appointments to be diagnosed. Some of our friends laugh about having to see a toothache and waiting until the toothache is well on its own before they get an appointment to see a doctor or haven’t gotten an appointment notice. Patients in the United States have to see a community doctor first before they can see a specialist. On the day of the appointment, the doctor knows how many patients he or she is seeing and the patient knows what time he or she is going. There are no crowded clinic halls, lines for registration, lines for payment, and lines for tests. All that is needed is a quiet not too long time to watch TV, read a book, and wait. Then make an appointment for the procedure and continue waiting. Chinese patients have no family doctor and no professional advice. They simply listen to what others say about how to do, then inquire about which hospital is famous in what place, and then commit to a relatively short consultation process with a lot of people. In this process, there is no advance guidance, no appointment for examination, consultation and treatment, but directly into the queue for consultation, examination, re-visit and hospitalization. Facing a large number of surrounding and the same patients in a short period of time creates a huge psychological pressure. 8. The spirit of adventure. Chinese medicine comes from the “black box” theory, the treatment of good or bad do not know. Western medicine comes from the origins of anatomy hundreds of years ago. What is anatomy? Is to open, take a closer look. This is a great look, the Chinese dead people pay attention to the whole body. The dead are still seeking integrity, the living open, the Chinese are more afraid. Western medicine has been introduced to China for about 100 years, so we have seen that surgical treatment is often effective and precise, such as a certain ball player, after what surgery treatment, soon regained athletic ability. But we also often see that once serious complications occur, they can greatly offset the effectiveness of the surgery and cause more harm to the patient, even less than before the surgery. Having surgery is similar to buying stocks in that both involve a certain amount of risk. The difference is that more than 90% of people who play stocks lose money. More than 90% of those who do surgery make money. Otherwise the principle of this surgery is wrong, or this doctor is wrong. It is clear that the excellent results of doing surgery are very high, but must be accompanied by risk. It is unrealistic to think only of the great benefits and refuse to accept the possible harm. There is no such thing as a surgery with only benefits and no harm. Only the benefits of surgery are talked about, not the risks of surgery. Doctors who have no surgical failure rate, no return rate, and who dare to pat themselves on the back are doctors who cannot be trusted. If you don’t have a little mental, physical and financial ability to bear the risk, don’t undergo surgery. 9.Mindfulness. After the above preparations, there is an essential understanding of the disease of lumbar disc herniation. It is not a malignant disease and there is no need to fear it. Try to choose surgical treatment in the first case only, in other cases, you can drag out the strategy and see where the disease goes. Is it getting worse? Or is it getting lighter? If it is the former strengthen the intensity and level of treatment, if it is the latter, you can continue conservative treatment, or even slowly return to normal life and work. 10. Refuse temptation. From the patient’s point of view, having a disease cannot be left untreated. Since treatment is bound to be financially costly, it is a normal thing in the business world. Although the state provides different percentages of reimbursement for different patients, but after all, they are not welfare and all-inclusive, be prepared to bear a certain percentage of the psychological and economic preparation. First of all the behavior of the commercial society, medical behavior is also involved in commercial behavior. Therefore, in the process of treatment, there will certainly be a certain amount of commercial marketing behavior. Some small, profitable hospitals advertise short and fast programs such as interventional treatments. Their indications are relatively wide, and patients must decide whether to receive treatment according to the severity of their disease. Then they can overcome the drawbacks of large hospitals, which have many patients and are difficult to see, and get better treatment results. As the saying goes, “don’t look at the advertisement, look at the efficacy”, in fact, we should face the advertisement rationally. The body hair and skin, the parents, do not dare to destroy, the beginning of filial piety. The third patient will hear some warning tips, if you do not hurry to do the surgery, will be how how …… the person concerned to screen, if you are the first case, such a warning is effective, is for your own good. If one is in the second case or third case, such warnings are not valid. It is even important to consider the medical background of this doctor, the size of the hospital, how many operations for lumbar disc herniation have been done, and whether his advice can be worth considering. We should remember that the first case has a lower chance of occurrence. 11, a small summary. Going to the doctor is a complicated matter, especially when you are faced with many methods. But remember, more methods are better than no methods at all. At any time, there is always nothing wrong with learning, and I wish you the best of luck in finding your own appropriate treatment method.