(1) Lumbar spinal stenosis: Nearly half of lumbar disc herniation coexists with spinal stenosis. Intermittent claudication is the most prominent symptom of the disease. After walking a certain distance, soreness, numbness and weakness appear in the lower limbs, and the walking can be continued only after squatting and resting; it is mostly asymptomatic when riding a bicycle and lying in bed. Sensation, movement and reflexes of the affected limbs often do not have any abnormal signs and are mainly judged by clinical judgment, and CT examination is helpful for diagnosis. (2) Lumbar spine tuberculosis: Patients usually have only low back pain and rarely have nerve root symptoms. However, neurological symptoms can occur when compressed by bone destruction, vertebral body collapse and cold abscess. Patients with tuberculosis mostly have systemic symptoms, such as hypothermia, night sweats, wasting, anemia, accelerated blood sedimentation, etc. X-rays show vertebral bone destruction, dead bone formation, narrowing of the vertebral space, and paravertebral abscesses, etc. CT scans have higher value for diagnosis. (3) Spinal tumor: low back pain in spinal tumor is mostly continuous progressive aggravation, obvious at night, and cannot be reduced by bed rest, while pain in lumbar disc herniation is generally intermittent, and bed rest can reduce the symptoms, and bone destruction is seen on spinal tumor imaging. (4) Intraspinal canal tumor: it can cause nerve root symptoms and even compress cauda equina nerve, causing cauda equina syndrome. However, lumbar intracanalicular tumor has the following characteristics: lumbar pain is persistent and obvious at night, and MRI examination can confirm the existence of intracanalicular tumor. (5) Strain injury: chronic strain injury of the lumbar region is mostly secondary to incomplete recovery from acute lumbar sprain, or caused by long-term poor work posture and overexertion. It may involve the buttocks or the back of the thigh, but the symptoms and signs mostly do not involve the calf and foot, and there are no muscle strength, sensory and reflex changes, and CT scan is needed when the differential diagnosis is difficult. (6) Lumbar spondylolisthesis: the common cause is the collapse of the arch and degenerative Xin caused by the clinical manifestations of intermittent claudication as a prominent manifestation, imaging can be clearly distinguished. (7) pear-shaped muscle syndrome: Tinel’s sign can be positive at the hip pressure in patients with pear-shaped muscle syndrome, and the pain is aggravated by passive hip flexion, internal retraction and internal rotation, and the “4” test can aggravate or induce sciatica by external force antagonism.