First, lumbar disc herniation can do laminectomy? Patient counseling case study: First of all, let’s look at a patient counseling case, this patient is a 27-year-old male with lumbar disc herniation. The patient felt pain in his lower back, pain and numbness in his right hip like a tear, and pain in his right leg, and numbness in his whole right leg up to the ring finger and little finger of his foot, and he couldn’t lie on his right side when he slept, and he couldn’t sit for more than 15 minutes. The MRI showed that the nucleus pulposus of lumbar 5 and sacral 1 had protruded backward, and the nerves were compressed bilaterally. This is a typical lumbar disc herniation lumbar pain with sciatic nerve pain, the patient also felt very painful when urinating and defecating, and urinary incontinence, which is a very serious complication of lumbar disc herniation – cauda equina syndrome performance, comprehensively speaking, this is an acute onset of the disease of the young patients, and it is a more severe This is a young patient with an acute onset of the disease and a more severe case of lumbar disc herniation. Is the patient in the case suitable for minimally invasive surgery or not? Since there was no face-to-face examination, based on his medical history and imaging results, I believe that this patient can still undergo minimally invasive surgery. II. If surgery is necessary, what are the surgical options? If a patient with lumbar disc herniation must undergo surgery, there are several choices of surgical methods, the first is the traditional laminectomy; the second is the minimally invasive endoscopic surgery (including intervertebral foramenoscopy); and the third is the fusion and immobilization of the disc at the same time of the discectomy, that is, usually referred to as the open fusion surgery. Third, which patients are suitable for laminectomy? First of all, we have to make clear what degree of lumbar disc herniation patients need to do surgery, first, conservative treatment has no effect, or conservative treatment is effective but recurrent attacks (two to three attacks within a year); second, the patient lumbar disc herniation attacks when the pain is very intense, and even have to maintain a certain position to reduce the pain (that is, medically referred to as a forced position); and then is the occurrence of Lower limb weakness, urinary and fecal abnormalities, or combined with lumbar spinal stenosis patients, all need surgical treatment. A large proportion of these patients requiring surgery have only one herniated disc, and these patients can be treated with minimally invasive intervertebral foraminoscopic surgery. Open fusion surgery requires the removal of the entire diseased disc, and in order to prevent the lumbar spine from becoming unstable, the remaining lumbar vertebrae may be secured with “nails”, which removes the “root cause of the disease” completely, but at the expense of spinal flexibility. The discs in the neighboring segments will be more prone to degeneration after the surgery, and the “nails” used for fixation may lose their function over time. Therefore, for young patients who have to use the waist for a long time, intervertebral foramenoscopy surgery is more advantageous; for some poor physical condition of the elderly patients, such as the combination of some medical diseases (heart disease, cerebrovascular disease, etc.) patients, can not tolerate “major surgery”, you can also choose minimally invasive surgery. Fourthly, for those who are not suitable for minimally invasive surgery for lumbar prolapse, do they have to choose to have an operation? Patients with lumbar disc herniation who are not suitable for minimally invasive surgery do not necessarily need open fusion surgery. There are many surgical options for lumbar disc herniation, including minimally invasive radiofrequency ablation, ozone therapy, intradiscal collagenase injections, or intradiscal injections of nucleus pulposus dissolving medications. In addition, there is also minimally invasive fusion and fixation surgery, although the principle of surgery and traditional open surgery is similar, but still smaller incisions, faster recovery. Is minimally invasive surgery necessarily better than traditional fusion surgery? What are the advantages and disadvantages of both? This depends on the patient’s specific situation. Minimally invasive surgery is characterized by less trauma, the surgical incision is less than one centimeter, less damage to the normal structure of the human body, so the patient will recover faster after surgery, usually four to six hours after surgery can go down to the ground, in the North Hospital usually the next day can be discharged from the hospital, which is open surgery can not be compared to some of the advantages. However, not all patients with lumbar disc herniation are candidates for minimally invasive surgery. For example, in one of the surgeries I did this week, the patient’s disc herniated into the spinal canal, and the herniated part wrapped around the side of the nerve, which was so badly adhered to the nerve that even with open surgery, the surgeon needed to operate very delicately in order to avoid nerve damage, and this kind of situation is not suitable for minimally invasive surgery. Through the above cases, we can see that minimally invasive surgery and traditional fusion surgery actually have their own indications, and it is not the case that one surgery is necessarily better than the other, and the doctor will choose the most suitable treatment plan according to the actual situation of the patient.