In winter, there is a significant increase in the number of patients with lumbar and leg pain, especially among the middle-aged and elderly, who often experience lumbar pain or pain in the lower extremities, which in severe cases affects walking and even rest. Most of these patients are diagnosed with lumbar disc herniation, lumbar spinal stenosis or lumbar spondylolisthesis. For patients with severe and recurrent symptoms, doctors usually recommend surgery. When many patients hear that their doctor recommends surgery, their main concern is not the effect of surgery, but the risk of surgery, especially if they will be paralyzed after surgery. So, how risky is it to have lumbar spine surgery? Is it true that paralysis can occur after surgery? To answer this question, we must first understand the mechanism by which the disease occurs. Lumbar disc herniation is due to the fact that with age, the disc gradually loses its elasticity and protrudes around under the action of external forces to compress the spinal cord and nerve roots, causing back pain and leg pain, and the purpose of surgery is to remove the protruding part of the disc. Lumbar spinal stenosis is a narrowing of the internal space of the lumbar spinal canal due to osteophytes, ligamentum flavum hypertrophy or disc herniation, which causes compression of the spinal cord and nerves. The goal of surgery is also to remove the factors causing the stenosis (osteophytes, ligamentum flavum, or herniated discs) and to relieve the nerve compression. Lumbar spondylolisthesis differs slightly from these two conditions in that it is caused by damage to or laxity of the connecting structures of the two adjacent vertebrae, resulting in instability and relative movement between the two vertebrae, which in turn compresses the nerve. The surgical strategy is to reset and fix the slipped vertebral body to relieve the compression of the nerve. It is easy to see that surgery of the lumbar spine is almost always performed around the nerves, which is the main reason why people worry about the high risk of surgery. In fact, the structure of the human lumbar spine, although complex, is very constant, and although each segment has its own characteristics, they vary little from person to person, and these characteristics have long been memorized by spine surgeons. In particular, the distribution of the spinal cord and nerve roots is very regular, and doctors who can perform lumbar spine surgery have a very good grasp of the distribution and location of these nerves, so the probability of accidentally injuring a nerve is very low. In addition, these surgeries are open surgeries, and these important tissues are protected in advance when decompressing the nerves and spinal cord. The lumbar spinal cord is protected by a tough dura, 20-30 mm in diameter, and the nerve roots are more than 5 mm in diameter, so it is easy to find and identify such large and important structures in front of the surgeon’s eyes, and there is little chance of accidental injury. In addition, when lumbar spine fixation or fusion is performed, it is done under intraoperative X-ray fluoroscopy and rarely touches the spinal cord or nerve roots. Therefore, it can be said that lumbar spine surgery is indeed very safe from the perspective of technical operation. Of course, safety is relative, and no surgeon can guarantee 100% absolute safety. As with other surgeries, there are risks associated with lumbar spine surgery in terms of individual differences. This is mainly reflected in perioperative accidents to vital organs such as the heart, brain and kidneys, and adequate preoperative examination and evaluation is an important means of avoiding accidents. Many patients with chronic low back pain are elderly, and a significant number of them have been suffering from the disease for several years or more before finally making up their minds to have surgery. After hesitating when their physical condition was good, by the time the condition became unbearable, their physical condition had changed relatively dramatically. Often, they are turned away from specialty hospitals because of chronic diseases such as concomitant myocardial ischemia, osteoporosis, hypertension, diabetes, cerebral infarction, etc. Because many specialty hospitals are weak in the presence of internal medicine, cardiology, etc., it is time to take advantage of the general hospital. The author’s hospital completes lumbar spine surgery for many complex and high-risk patients every year because of the balanced development of various specialties in general hospitals, which are backed by not only the excellent technology of spine, but also the strong technical strength of anesthesia, internal medicine, critical care, cardiology and other specialties, which can ensure patient safety. Therefore, it is also recommended that all patients with back and leg pain should make up their mind to have surgery as soon as possible, so that they can return to a healthy and happy life. If it is difficult to undergo surgery due to medical reasons, you may want to go to a few more general hospitals for another consultation.