Many people in life have had the symptoms of low back pain, are thought to be sedentary or exertion caused by muscle injury, recuperation will be good, did not pay too much attention. Over time lumbar pain can not be relieved, serious patients are also accompanied by obvious nerve compression symptoms, such as leg pain, leg numbness, and so on, which is anxious to see a hospital. After checking the lumbar spine is found to be out of the problem, heard the doctor recommended surgery, immediately panicked – conservative treatment can not? Really to the extent of surgery? Before we talk about treatment, let’s first understand the structure of the lumbar spine. The middle of the lumbar spine is hollow, called the spinal canal, the spinal cord and nerves pass through the spinal canal; the part between the two vertebrae is called the intervertebral disc, which consists of cartilage endplates, annulus fibrosus and nucleus pulposus. The nucleus pulposus is located in the center of the intervertebral disc, which is a water-rich, jelly-like elastic protein that acts as a cushion to prevent the two bones from directly impacting. Surrounding the nucleus pulposus is the annulus fibrosus, a layer of which connects the two vertebrae together and holds the nucleus pulposus firmly in the center. The cartilaginous endplates are located at the junction of the vertebral bodies and the intervertebral discs. Common lumbar spine disorders include lumbar disc herniation, lumbar spinal stenosis, lumbar spine slippage, lumbar degenerative scoliosis, intervertebral discogenic low back pain, and lumbar spine fracture. The indications for whether surgery is needed vary from one lumbar spine disorder to another. Lumbar disc herniation refers to the rupture of the annulus fibrosus of the intervertebral disc, and the nucleus pulposus protrudes (or prolapses) from the ruptured area into the posterior spinal canal, leading to irritation or compression of the adjacent spinal nerve roots, which produces a series of symptoms such as lumbar pain, numbness, and pain in one lower limb or both lower limbs. Patients should consider surgery if they have progressive decrease in muscle strength; cauda equina syndrome (a series of neurological dysfunctions due to compression of the cauda equina nerve), such as numbness of the lower limbs, difficulty in urinating and defecating or even loss of control, etc.; or if the effect is still not good after rigorous conservative treatments, and the patient is unable to live a normal life. In addition, repeated episodes of lumbar disc herniation pain, combined with spinal stenosis (spinal stenosis is often caused by ligament thickening and osteoarthritic hyperplasia, the space of the spinal canal becomes smaller) will aggravate the compression of the nerves, and the effect of conservative treatment is often not good, and in this case, surgery is also recommended. Some patients have large herniated discs, which may cause sudden nerve damage during exercise, and herniated discs are unable to return to their original position on their own, so surgery is recommended as soon as possible. Lumbar spinal stenosis is a condition in which the diameter of the spinal canal becomes smaller, leading to compression of the nerves passing through the canal and causing neurological dysfunction such as lumbar and leg pain, numbness, and intermittent claudication. If the patient’s spinal canal becomes significantly narrower, the compression of the nerves affects the quality of life, and conservative treatment is not effective, surgery is recommended. Lumbar spondylolisthesis refers to an abnormality (e.g., cracking) of the bony junction (isthmus) between neighboring vertebrae or degeneration of the small joint articulation, which results in a particular lumbar vertebrae slipping forward or backward. Slipped lumbar vertebrae can lead to narrowing of the spinal canal, and in order to maintain the stability of the lumbar vertebrae, the surrounding small joints will proliferate to “support” the slipped lumbar vertebrae. However, these newly grown bony cumbers will make the narrowing of the spinal canal even worse, causing patients to experience recurrent symptoms such as low back pain and numbness in the lower extremities. This disease is difficult to alleviate through conservative treatment and should be treated with surgery. Degenerative scoliosis of the lumbar spine is a scoliosis of the spine that occurs due to the aging of the intervertebral discs and lumbar bony joints, which leads to inconsistencies in the thickness of the vertebral bodies or discs. Patients with simple low back pain are still recommended to do strict conservative treatment; if combined with symptoms such as lower extremity numbness, pain, intermittent claudication, etc., it indicates the presence of spinal stenosis and other factors that lead to nerve compression, which requires surgical release of the compression and appropriate correction of lumbar scoliosis. Intervertebral discogenic low back pain refers to chronic lower back pain caused by aging and inflammation of the intervertebral discs, which stimulates the pain receptors of the intervertebral discs, but is not accompanied by symptoms of nerve compression, such as numbness in the legs. Such patients cannot sit for long periods of time, usually only for about 20 minutes. If sedentary or strenuous, the pressure on the intervertebral discs increases and the low back pain worsens. Conservative treatments such as plasters have little effect and often require surgery.