Background] Lumbar disc herniation has become a household disease, and the age range of patients is very wide, from young men under 20 years old to elderly patients in their 80’s. They have various understandings of lumbar disc herniation, and they have the same tangle about whether to have surgery. Moderator: On the Archimedes platform, an MRI report of a medical examination of Uncle Zhang said that he was found to have a lumbar disc herniation, but he usually has no lumbar discomfort or leg pain, so he was hesitant to undergo surgery. Medical doctor: Generally speaking 80%-90% of patients with lumbar disc herniation can get significant relief from their symptoms after conservative treatment. The need for surgery does not depend solely on the size of the herniation as shown by CT, MRI and other imaging tests, but mainly on the severity of the symptoms and the impact on normal life and the effectiveness of conservative treatment. Moderator: What are the main methods of conservative treatment and can you briefly introduce them? Doctor: When the first attack of symptoms and pain is severe, bed rest should be “absolute”, although the word “absolute” is not scientific enough, but very practical. However, it is worth emphasizing that one should not get out of bed or sit up when eating, drinking or urinating, in order to receive good results. Bed rest is not absolute immobility, but functional exercises can be carried out in bed to avoid muscle wasting atrophy and prevent adhesion of nerve roots, which will help the recovery of the disease in the future. Moderator: So can I take painkillers? Is it true that tui na and massage are effective? Doctor: In addition to bed rest, medication can be used, such as antipyretic and analgesic drugs like Lapsone and Xilab. Or traction, tui-na, massage treatment, but these need to exclude the nerve. If it is still ineffective, the patient can go to the hospital and be treated with joint closure, mannitol or hormone therapy according to the specific situation. Moderator: How long does conservative treatment usually take? Doctor: We generally recommend 3-6 months, and if conservative treatment is not effective, surgery should be considered. If conservative treatment does not work, surgery should be considered. However, it varies from person to person, and if the condition requires conservative treatment for less than 6 months, surgery is needed as soon as possible. Moderator: Can you tell us specifically which conditions require surgery? Doctor: First of all, we would like to emphasize that when the patient has numbness, atrophy, weakness of the lower limb muscles, such as the back of the foot can not be lifted, or feel that there are obstacles to urination and defecation. These symptoms suggest that the patient already has nerve dysfunction and should be treated with surgery as soon as possible to release the nerve compression. Otherwise, the nerve is like a small grass pressed by a stone, which will cause permanent functional damage over time. Moderator: In addition to nerve function, is pain a factor for you to consider surgery, or can you only tolerate it? Doctor: Yes, the severity of the patient’s symptoms and the degree to which it affects the quality of life are factors that we consider whether we should operate. For patients with severe pain symptoms, if conservative treatment is not effective, early relief of the patient’s pain is also our goal for surgery. There is a common international scale to assess the degree of pain and impact of the disease on the patient’s life. Doctor: I think of a situation, let’s say I got better after 2 months of conservative treatment, but the pain started again after about 3 weeks, and then got better again after conservative treatment, and it has been repeatedly tossed around for a year. Doctor: For patients with recurrent symptoms like this, we generally recommend surgery. Although surgery cannot be done once and for all, the recurrence rate is much lower than conservative treatment, so we think surgery is meaningful in this case. Moderator: Speaking of the effect of surgery, will the patient’s symptoms definitely improve after surgery? Doctor: It should be said that most of the patients will improve, and very few may not be ideal. The patient’s symptoms are caused by various factors, including nerve compression, local chemical irritation, and muscle and soft tissue strain. The role of surgery is to remove the nerve compression, and for pain caused by chemical irritation medications are also needed to assist in the treatment. In addition, as mentioned earlier, surgery does not restore nerve function if the nerve compression is prolonged and causes permanent damage to nerve function. Moderator: Nowadays, minimally invasive surgery is very popular, so is it better to treat lumbar disc herniation with traditional or minimally invasive surgery? The minimally invasive treatment that people are most familiar with now is the lumpectomy technique. For example, a general surgeon can perform some surgeries that used to require opening the abdominal cavity by just making a few small holes in the stomach. Spine surgery is far more difficult than other disciplines because it operates in bony tunnels and cannot effectively expand the operating space with the help of tools. Minimally invasive lumpectomy in spine surgery, operating in a spinal canal that is only about one centimeter thick, is very demanding on the surgeon, and unskilled operation is more likely to cause vascular and nerve damage. Therefore, it is not the case that minimally invasive surgery is less invasive and less risky. Patients with post-surgical complications of lumbar synostosis are often seen in outpatient clinics after minimally invasive surgery. Minimally invasive also includes small incision techniques, with limited incisions supplemented by lumpectomy or microscopy. However, the concept of minimally invasive goes beyond small incisions. Many spine surgeons use microscopes based on traditional surgery to achieve finer non-invasive or minimally invasive operations with less nerve and vascular damage. There are specific indications for the use of minimally invasive techniques, and only when applied properly and with great skill in minimally invasive techniques can the goal of less trauma and faster recovery be achieved. Traditional surgery with continuous improvement and innovation is still a good choice. The best surgery is the one that suits the patient’s condition. Moderator: Are there any patients who cannot have surgery? Doctor: Patients with simple lumbar pain need to be careful when choosing surgery because typical patients with lumbar synostosis have sciatica in the lower extremities, which can be accompanied by leg pain, and the causes of lumbar pain are very complex, so it is difficult to confirm that simple lumbar pain is caused by lumbar synostosis. A clear diagnosis is needed before surgery, so some patients whose diagnosis is not yet clear, or who have poor health conditions or serious medical diseases that cannot tolerate surgery should choose surgery with caution. Moderator: Is surgery not recommended for the elderly? However, if the patient is able to tolerate the surgery according to the preoperative examination, we can also treat the patient surgically. Moderator: What are the main risks of surgery? Doctor: Surgery for lumbar disc herniation is a mature surgery. As long as the diagnosis is clear, the preoperative preparation is adequate, the operation is carefully performed, and the postoperative period is closely observed, the risk of surgery is not significant for experienced physicians. Among the possible risks are mainly bleeding, dural injury and nerve injury.