The Spine Disease Outcomes Research Trial (SPORT) showed that surgical treatment of lumbar disc herniation resulted in better outcomes than non-surgical treatment in a 4+ year study [1-3]. However, these studies were group comparisons between surgical and non-surgical procedures only, and they also showed that demographic characteristics, imaging, clinical as well as pathological features may have an impact on the clinical outcome of individuals. However, which patients are most suitable for surgical or nonsurgical treatment has not been clearly concluded by previous studies. As a result, certain patients who are more suitable for surgical treatment may be given the wrong advice by their physicians and opt for non-surgical treatment; the opposite is also true. In order for physicians and patients to make truly informed treatment decisions, it is necessary to identify the relevant predictors of success for both surgical and non-surgical procedures. As a result, SPORT Research has conducted a large-sample prospective randomized controlled study in conjunction with an observational cohort study, the results of which are forthcoming in the journal Spine. Patients with lumbar disc herniation in the study came from 13 hospitals in 11 states, 788 were treated surgically, and 404 underwent non-surgical treatment. All were older than 18 years of age, and inclusion criteria were neurogenic pain with positive signs of nerve root compression or neurological deficits, imaging-confirmed herniated discs compatible with clinical symptoms, and duration of symptoms longer than 6 weeks. Exclusion criteria were cauda equina syndrome, malignancy, significant deformity, history of previous low back surgery, and other obvious contraindications to surgery. The surgical group underwent a standard open discectomy (nucleus pulposus removal) to explore and decompress the involved nerve roots, with intraoperative application of magnification or microscopy whenever possible. The nonsurgical treatment group received routine management, including at least the following: physical therapy, health education and counseling, instruction in home functional exercises, and if not contraindicated, nonsteroidal anti-inflammatory drugs. The researchers identified 37 underlying variables by which the patients were divided into subgroups, and calculated a time-weighted mean treatment effect based on the Oswestry dysfunction score (ODI, the higher the value the more pronounced the dysfunction and the greater the negative value the more pronounced the remission after surgery compared to the preoperative period) through a 4-year follow-up study, with treatment effect (TE) = ?ODI surgical -?ODI non-surgical. Variables with a significant effect on treatment were added to the multivariate model to identify independent predictors of efficacy. These 37 underlying variables are detailed in Table 1. The final analysis for each subgroup showed a more significant improvement in ODI with surgical treatment than with non-surgical treatment (p<0.05). Slightly corrected univariate analyses found greater TE (more significant relief with surgical treatment) for those who were married, had no joint disease, had a tendency to worsen symptoms, had no higher education experience, were elderly, had no workers' compensation, had a longer duration of symptoms, and had a score below 35 on the psychosomatic component (MCS) of the SF-36. Multivariate analysis showed that being married (TE: married-15.8 vs. single-7.7, p<0.001), having no joint disease (TE: none -14.6 vs. with -10.3, p=0.012), and worsening symptoms (TE: worsening-15.9 vs. stable-11.8, p=0.032) were independent predictors of surgical outcome. The difference in surgical outcome was most pronounced in patients who were married and had worsening symptoms compared to those who were single and had stable symptoms (-18.3 vs -7.8). The authors conclude that patients with lumbar disc herniation, strictly capturing the inclusion criteria (as described above), undergo greater improvement with surgical treatment than with non-surgical treatment, independent of their idiosyncratic individual characteristics. However, patients who are married, do not have joint disease, and have a tendency to worsen their symptoms may have more significant results with the choice of surgical treatment. Key Points: Patients with lumbar disc herniation can achieve more significant improvement with surgery than with non-surgery, independent of their individual-specific characteristics, provided that the inclusion criteria are strictly followed. Patients who are married and have no joint disease and whose symptoms tend to worsen from baseline undergo surgery have a more pronounced clinical outcome. Some individual characteristics such as low education, low MCS scores, and long duration of symptoms tend to have poorer final outcomes, but surgical treatment has relatively better results. Lumbar disc herniation is a very common clinical condition and one that is currently extremely confusing to treat clinically. Spine surgery, orthopedics, physical therapy, pain, Chinese orthopedic injury, rehabilitation, massage, acupuncture, charlatanism, etc. may all encounter this type of disease, and the diagnostic confusion is extremely serious, but this is not the focus of this article. Another issue of great controversy is the issue of indications for surgery. From this study, it appears that patients who met the inclusion criteria for the SPORT study had better clinical outcomes with the surgical option. To reiterate this inclusion criteria: neurogenic pain with positive signs of nerve root compression or neurological dysfunction, imaging-confirmed herniated disc consistent with clinical symptoms, and duration of symptoms longer than 6 weeks. In clinical work, it should be more appropriate to use this inclusion criterion as an indication for surgery for lumbar disc herniation. It is noteworthy that previous studies have concluded that patients with low education level, psychosomatic problems such as depression and anxiety, and long duration of symptoms have poorer surgical outcomes and should be carefully selected for surgical treatment. In contrast, the findings of this study showed that both surgical and non-surgical outcomes were poorer in these patients, but relatively speaking, surgical was more effective than non-surgical. In addition, although patients meeting the above criteria have better surgical outcomes, non-surgical treatment is not useless, and many patients with indications for surgery can achieve satisfactory clinical outcomes with non-surgical treatment.