1, lumbar disc herniation nucleus pulposus removal surgery Traditional lumbar disc nucleus pulposus removal surgery mainly has a posterior interlaminar window, hemilaminectomy, total laminectomy and so on. Under the premise of adequate decompression, the surgery can preserve the integrity of the spinal canal, prevent postoperative scar adhesion and compression of the nerve root as much as possible, preserve stability and prevent vertebral body from slipping out of the vertebral body. The advantages of this type of surgery are clear field, easy operation, direct removal of the intervertebral disc, adequate decompression of the nerve root, and accurate results in most patients. The disadvantages of this type of surgery are that there is scar formation at the operation site and adhesion with the dura mater, which may compress the dural sac and nerve root, and may also cause lumbar spine instability and heterotopic ossification, resulting in a variety of clinical complications in some of the patients, and bringing difficulties and dangers to the reoperation. 2, intervertebral fusion The purpose of intervertebral fusion is to eliminate the lumbar joint protrusion and disc structure damaged and destabilized after intervertebral disc surgery, and to eliminate the pain stimulation of synovial membrane of joint protrusion and joint capsule, posterior longitudinal ligament behind the intervertebral disc, and sinusoidal nerve endings in the front of dura mater. Previously, most of the large iliac bones were used for simple fusion, but nowadays, various fusion devices combined with bone graft fusion are used in clinical practice. Interbody fusion can restore the height of the intervertebral space, enlarge the intervertebral foramen, relieve the symptoms of nerve compression, and increase the stability of the affected segments. However, the cost is high, there is a certain degree of difficulty in operation, and often some patients can not fully achieve the expected goals of the operation. 3.Artificial intervertebral disc replacement In 1996, Robert of Germany firstly carried out artificial intervertebral disc implantation, and the application of intervertebral disc prosthesis has a history of more than 40 years. Artificial disc replacement has the following advantages: ① Restore the height of the intervertebral space and intervertebral foraminal volume. ② Does not increase the stress load of adjacent segments. (iii) It has a certain degree of mobility after the operation. ④Thorough removal of disc tissue, eliminating the source of inflammatory irritation and autoimmune reaction. Artificial lumbar disc replacement is a new means of treating lumbar disc herniation. Its near-term efficacy is satisfactory, but the long-term effect requires further clinical observation and follow-up. Indications for artificial disc replacement: ① 18 years of age or older; ② single-segment symptomatic degenerative disc disease, non-surgical treatment for more than 6 months is ineffective; ③ lower back pain (with or without leg pain); ④ imaging tests confirmed that the disc origin of the signs and symptoms of abnormalities consistent. Minimally invasive surgery for lumbar disc herniation (1) Radiofrequency ablation myeloplasty Radiofrequency ablation myeloplasty was firstly used for clinical treatment of lumbar disc herniation in July 2000 in the United States, which is a kind of minimally invasive technology for treating disc herniation, and it is a kind of new technology between the conservative treatment and open surgery. It is suitable for patients with mild-to-moderate disc herniation accompanied by low back pain or lower extremity pain and the elastic structure of the posterior aspect is intact as shown by the dynamic laminography. Decompression is most effective when the annulus fibrosus is still intact, and surgery is largely ineffective if both the annulus fibrosus and the posterior longitudinal ligament have ruptured. It is characterized by the ability to remove a large amount of diseased tissue without causing irreversible damage to the surrounding normal tissue. The procedure has the advantages of simple operation, safety, and minimal trauma, with the disadvantage that it requires a high investment in equipment. It is less damaging to the body than posterior discoscopic techniques or open surgery. (2) Percutaneous Laser Disc Decompression (PLDD) Percutaneous Laser Disc Decompression (PLDD) is a percutaneous puncture technique that reduces the pressure in the intervertebral disc by vaporizing and cutting the nucleus pulposus and coagulating it with a laser, so that the herniated intervertebral disc can be reduced in tension and retracted to achieve the therapeutic purpose. This procedure was first clinically reported by Choy et al. in the United States in 1988. PLDD is less invasive, easy to operate, safe and effective. Indications for surgery are first based on clinical symptoms, but the success of the procedure depends on the results of discography. The main problem is that percutaneous laser disc decompression is greatly affected by laser output power and operation technique. (3) Endoscopic lumbar discectomy via intervertebral foramen In 1996, Kambin firstly reported the use of this route to treat lateral recess stenosis due to lumbar disc herniation. However, because the intervertebral foramen is a bony fibrous channel with a fixed inner diameter, through which a nerve root passes, it is difficult to operate with high requirements for endoscopy and surgical instruments. It is reported that many domestic experts apply this technology to treat a number of patients with lumbar disc herniation and achieve satisfactory results. (4) Complete endoscopic transforaminal approach surgery for lumbar disc herniation Minimally invasive surgery has the advantages of less trauma, less bleeding, faster recovery, fewer complications, and can maintain the stability of the spine, etc., which is a leap in the history of lumbar disc herniation treatment. With the rapid development of minimally invasive techniques in spinal surgery, minimally invasive surgery is likely to gradually replace many traditional open surgeries. However, minimally invasive surgeons are required to have the skills of open surgery, because of the possibility of complications during surgery or the need to switch to open surgery when the minimally invasive surgery itself encounters insurmountable difficulties. Other therapies Myelinolytic enzyme therapy Indications: Generally used as the most conservative minimally invasive therapy for patients who have failed conventional conservative therapy. Contraindications: allergy; cauda equina symptoms; pregnant women and children under 14 years of age. According to the reported analysis and our clinical observation about one-third of people are ineffective and two-thirds are effective. Complications include intervertebral discitis, nerve root injury, hematoma of lumbar major muscle, and so on. Conclusion In summary, the surgical treatment of lumbar disc herniation has evolved over the past 70 years, and although the indications, contraindications, and risks of the various methods vary, the overall goal is the same, which is to give the patient the least amount of pain, the least financial burden, and the least number of potential surgical complications on the basis of safer, simpler, and more convenient treatment, which is the real responsibility of clinicians. Although no method is perfect, we must do our best to choose an optimal treatment plan for our patients that will relieve them as completely as possible. How to solve recurrence and further improve surgical operation techniques and surgical operation instruments are the direction of our research.