Currently, there is some confusion about the diagnosis of spinal disorders in China. Many departments are being looked at, and the people do not know which department is the best place to go for consultation. Very few people think that minimally invasive disc surgery can solve all back and leg pain, but in fact, many back and leg pains are not caused by herniated discs at all. These people have minimally invasive surgery that does not help, but increases the risk. Here is advice for patients with low back pain: causing low back pain is not necessarily a herniated disc, low back pain does not necessarily require surgery; minimally invasive is not necessarily the best surgical option; before receiving regular treatment, it is necessary to visit the spine surgery department to discuss which treatment option is suitable for the patient! Let’s start with a few questions: 1. Is lumbar disc herniation the same thing as lumbar disc herniation? 2. Is lumbar pain + thigh pain + lumbar disc herniation enough to diagnose lumbar disc herniation? 3.Conservative treatment of lumbar disc herniation must be bed rest? 4.Is surgery necessary if there are neurogenic signs and symptoms of lumbar disc herniation? If you are sure about these questions, there is no need to read on the following content. Lumbar disc herniation A herniated disc is a rupture of the intervertebral disc’s annulus fibrosus, with the nucleus pulposus tissue protruding (or prolapsing) from the site of the rupture in the posterior or spinal canal. This is really just a pathological change, or imaging manifestation, and is almost inevitable in the human aging process, just like the appearance of wrinkles on the face and graying hair, it is not a disease. According to the literature, there is a high incidence of lumbar disc herniation in asymptomatic people. One study performed MRI scans on 102 asymptomatic volunteers, aged 14-82 years with a mean of 46.3 years, and found rates of disc herniation, annulus fibrosus tears, and nucleus pulposus degeneration of 81.4%, 76.1%, and 75.8%, respectively. A study published in the JBJS showed that more than 20% of asymptomatic volunteers under the age of 60 had disc herniation, and a study in Spine also showed that 40% of asymptomatic volunteers under the age of 30 had disc degeneration, rising to 90% of volunteers aged 50-55. Additional long-term follow-up studies have found no correlation between the presence of herniated discs in these volunteers and the subsequent development and duration of low back pain. Lumbar disc herniation Lumbar disc herniation, on the other hand, is a clinical syndrome in which a herniated lumbar disc causes irritation or compression of adjacent spinal nerve roots, resulting in a series of symptoms such as low back pain, numbness and pain in one or both lower extremities. In fact, in the English literature and monographs, there is no such term as lumbar disc herniation, but the terms “sciatica” (sciatica) and “lumbar disk herniation” (lumbar disc herniation) appear very frequently in the relevant literature, and in many contexts are probably similar to the Chinese term “lumbar disc herniation “in many contexts. Of course, the expression “asymptomatic lumbar disc herniation” is also used. Professor McCulloch was a landmark figure in the study of lumbar degenerative disease, and his diagnostic criteria have been used to date: 1. leg pain greater than lumbar pain, mainly confined to the sciatic or femoral nerve innervation area; 2. abnormal sensation in the dermatomes; 3. positive straight leg raise test with an angle of less than 50% of normal, or positive straight leg raise test on the healthy side; 4. muscle atrophy, weakness, hypoesthesia 2 of the 4 items such as muscle atrophy, weakness, hypoesthesia and weakened tendon reflexes; 5, imaging features consistent with clinical manifestations. According to the above diagnostic criteria and the pathological features of lumbar disc herniation, lumbar disc herniation must not only have pathological changes of lumbar disc herniation (imaging manifestations), but also must have clinical manifestations of damage to the corresponding nerve structures, pain and numbness, etc. with root distribution. Therefore, even if there is an obvious lumbar disc herniation on imaging and there is also regional pain in the lumbar region, buttocks or thighs, etc., the diagnosis of lumbar disc herniation is questionable if there is no pattern of radicular distribution of nerves. Must I be bedridden for conservative treatment of lumbar disc herniation? Most domestic monographs, Chinese literature, and even textbooks advocate that conservative treatment of lumbar disc herniation must be strictly bed rest. However, a search of the English literature suggests otherwise. Spine, the most authoritative journal of spinal surgery, has published a Cochrane systematic review with the highest level of evidence-based medicine, concluding that patients with acute low back pain are advised to obtain fewer gains (pain, functional recovery) from bed rest than from continuing to maintain daily activities; and that there is little difference between bed rest and maintaining activity in patients with lumbar disc herniation. There is a large body of literature that is consistent with these views and few studies have been reported that advocate strict bed rest. This shows 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. There is no uniform opinion on the indications for surgery for lumbar disc herniation. But should surgery be performed if there are typical neurological symptoms and signs? From the viewpoint of high-quality literature such as NEJM and BMJ, surgery can be considered for patients with clearly diagnosed lumbar disc herniation (1) presenting with cauda equina syndrome or acute severe local paresis or progressive worsening of paresis; and (2) with intractable radicular pain (not relieved by morphine) or not relieved by systematic conservative treatment for 6-8(12) weeks. Overall, surgery is safe and has a lower complication rate, and symptoms are usually improved faster and to a greater extent with surgery; however, non-surgical procedures are also safe, unless cauda equina syndrome is present as well as progressive nerve damage at home, and non-surgical treatment is chosen for a better outcome in the end. This means that most discectomies can be avoided and without any long-term damage. If their symptoms are intolerable, surgical treatment may be considered if early recovery is desired. For patients with a herniated lumbar disc with non-specific back pain, please do not have the disc operated in the name of lumbar disc herniation.