Is surgery necessary for lumbar disc herniation? What kind of lumbar disc herniation requires surgery? Lumbar disc herniation: There are two absolute indications for surgery: 1. cauda equina syndrome, i.e., skin numbness behind the buttocks, hypesthesia, or urinary and fecal dysfunction (constipation, or incontinence); 2. single nerve root palsy (i.e., dorsiflexion of the thumb, flexion disorder, muscle weakness, or muscle atrophy); these two points are absolute indications for surgery. Other relative indications for surgery: 1, severe pain seriously affects life and conservative treatment is ineffective; 2, huge disc herniation; 3, conservative treatment is ineffective for 3 months and pain seriously affects life. I have nothing to say about the absolute indications for surgery for lumbar herniation, that is, once this condition arises, it must be treated surgically, and these two are also the consensus of the academic community. When is surgery necessary? What is the timing of surgery? My opinion is that once the diagnosis of cauda equina syndrome is confirmed, surgery is needed immediately, which is also well understood. Let’s say that the protruding nucleus pulposus is compressing the cauda equina nerve, like an earthquake, the house collapses and smashes the person underneath. Or is it better to delay the rescue for a long time? The answer is yes, it is necessary to save the person immediately, that is, the nucleus pulposus needs to be removed immediately to release the compression of the cauda equina, otherwise, if it is late, the symptoms of the nerve will not be easily recovered, and it is likely to leave sequelae. Regarding the second relative indication, many patients and friends are confused. Do I have to go through strict conservative treatment for 3 months or 6 months? My view on the “relative indications” is that it depends on the symptoms and your needs! For the relative indications for surgery, conservative treatment for 3 months to 6 months was a standard that was set a long time ago. At that time, there were no minimally invasive techniques such as intervertebral foraminoscopy. Nowadays, with the maturity of minimally invasive techniques such as intervertebral foraminoscopy, it is possible to perform day surgery and be discharged the same day or the next day, and the cost is not high. Therefore, patients with lumbar herniation should ask themselves whether they can endure such pain for such a long time. Nowadays, with such fierce competition in work or study, has anyone given themselves the opportunity to be treated conservatively for such a long time? If the results are not good after 3 months of strictly conservative treatment, then surgery should be done, and the time spent and the pain endured should be accepted and recognized by the patient. Of course, most of the lumbar disc herniation can still be treated conservatively. This part is not an indication for surgery, so it is not part of the discussion.