For lumbar disc herniation, cauda equina damage is the only absolute indication for surgery. This means that if a patient presents with defecation impairment, surgery should be performed as early as possible, usually within 24 hours, is recommended. If delayed, the recovery of bowel function is not ideal. In addition to this, for herniated discs in general, since 80-90% of patients can improve with conservative treatment, we recommend conservative treatment first for patients with a first episode. Conservative treatment generally ranges from 2 months to 6 months, depending on the effectiveness of conservative treatment. For patients with sensory numbness and progressive muscle weakness in the lower extremities, we recommend that the patient should have frequent follow-up visits so that the doctor can pay close attention to the changes in the condition. For those patients who have failed conservative treatment and developed loss of skin sensation in the lower limbs, progressive muscle weakness, or even foot drop, we also recommend early consideration of surgery. If the compression is not removed as soon as possible, it will be difficult to recover from these symptoms even if surgery is chosen later. Most patients have had a herniated disc for some time, and their symptoms have been recurrent, sometimes mild and sometimes severe. Whether or when to choose surgery is a common question. In fact, many patients with lumbar disc herniation often have herniated discs not by chance, some are due to the presence of congenital lumbosacral variants, such as lumbar sacralization or sacral lumbarization, lumbar transverse process hypertrophy, etc. These variants will continue to put the diseased disc in an abnormal stress state, so the effect of conservative treatment is not easy to maintain for a long time, which is the reason for the recurrence of symptoms. Some are due to poor lifestyle habits or the nature of work, such as obesity, long hours of seat work, lack of activity and exercise, etc. If these conditions are not changed, these factors will also continue to act on the lumbar discs, thus causing recurrent symptoms of lumbar disc herniation. On the other hand, lumbar disc herniation is a manifestation of lumbar spine degeneration (commonly known as “aging”), which occurs with age, just like our skin and hair. The normal human lumbar intervertebral disc reaches its peak of maturity at the age of 25, after which it begins to degenerate gradually. Therefore, after a lumbar disc herniation, although after a period of time part of the disc can shrink and reduce the volume, or surface fibrosis to repair the fissure, but it is still on the “downhill” of degeneration, so it is easy to trigger symptoms again under some triggers. Therefore, it can be said that once a disc is herniated, it can be a lifelong thing. You need to pay attention to it and protect it throughout your life. During the remission period, you should not do actions that hurt it, such as intense exercise, excessive weight bearing, or even bending over to carry weight, etc. It is important to develop the habit of exercising to exercise the flexibility and muscle strength of the low back. If the recurring episodes of low back pain are very frequent, and each episode lasts for a long time, and rest is necessary to maintain a pain-free state, then I recommend that the patient consider surgery. I often meet young patients (patients with lumbar disc herniation are usually younger, between 20-40 years old) who have been ill for a long time, have chosen various conservative treatments that have not worked, and have interrupted their studies or quit their jobs to stay home. For them, my advice is often to encourage them to consider surgery. Because they are young, they are at the beginning of their studies and work, and society and their families will demand a lot from them in the future, so it is not good for them to stay at home for a long time. The same reasoning applies to all people who have a high demand for quality of life. I often use a scale to explain whether or not to choose surgery. One end of the scale represents the pain of the disease and the other end represents the pain of the surgery and the risk of the surgery. If the pain is greater than the risk of surgery, then surgery is the choice; conversely, if the pain is not as severe, then conservative treatment continues. It is like going from Beijing to Urumqi, Xinjiang, is it by plane? Or do it by horse-drawn carriage? The former is fast, but risky; the latter is slow, but safe. This example may not be so apt, it’s already the 21st century, why don’t we enjoy the convenience and safety brought by modern technology? The progress of modern medicine is reflected in the safety of surgery, and this can be trusted.