After a period of ineffective conservative treatment, patients who should have opted for surgery continue to suffer from the disease because they are afraid of surgery, and some even have residual symptoms such as lower limb numbness and limited mobility (claudication). The main reasons for fear of surgery are concerns about the risks of surgery and post-surgical pain. Here, I would like to give a brief introduction on the risks of surgery and post-surgical pain to provide some reference for your decision making. I. About the risk of surgery First of all, I would like to explain that any surgery has risk, which is a very recognized phrase. However, what are the risks? How big is the risk? What is their incidence? This is the most important question for everyone. In fact, the risks of lumbar spine surgery cover a wide range, which are mainly summarized as follows: first, the risks during anesthesia; second, the risks during surgery; third, the risks after surgery; and fourth, the risks of complications. I would like to briefly describe the most common surgical risks that patients are most concerned about. 1, anesthesia risk Any surgery must go through anesthesia. At present, the main choice of lumbar spine surgery is general anesthesia, that is, after tracheal intubation, ventilator to maintain breathing, intravenous administration of anesthetics or intravenous and tracheal inhalation (anesthesia) combined with the safety of these drugs is very good and easy to control, coupled with the current advances in technology, real-time monitoring of heart and lung function and bleeding during surgery, its safety is very high. However, risks still exist, such as allergic reactions to drugs, cardiac arrhythmias, cardiac arrest, overdose due to individual differences in sensitivity to drugs, etc. These factors are all accidental factors that cannot be prevented. There are also factors that lead to injury during the operation, such as injury to the airway and voice box, reflux of food or digestive juices causing reflux trachea and lung injury, and finally pneumonia. I don’t want to talk about the risks of anesthesia in detail here, I want to focus on the risks of the surgical procedure. 2. Risks of the surgical procedure The lumbar spine disease involves the cauda equina or nerve root. What is the cauda equina? When the human body is mature, the lowest point of the spinal cord is at the lower edge of the second lumbar vertebral body, and the nerves emanating from the spinal cord are wrapped by the dura mater below. The cauda equina travels downward and exits the neural foramen at the corresponding segment, and the nerve root is formed by the dura before it exits the neural foramen. A herniated disc or spinal stenosis involves either the cauda equina or the nerve roots. The central type of herniation compresses mainly the cauda equina, and the nerve roots on one side are compressed when it is on one side. There are many causes of lumbar spinal stenosis, mainly lumbar disc herniation, ligamentum flavum hypertrophy, nerve root canal stenosis, and osteophytes. The purpose of surgery is to release these compression factors. Then, there is a risk of damaging the nerve roots during the surgery. The nerve root will lose its original normal anatomical structure after prolonged compression, making it difficult to identify during surgery resulting in misinjury, or the nerve root must be distracted from the already compressed nerve root when removing the anterior compressor during surgery due to excessive compression of the nerve root, resulting in temporary or permanent dysfunction (paralysis) of the nerve root due to distraction injury. Injury to a single nerve root is an incomplete palsy, with the end result being numbness and walking claudication. The longer the patient’s disease duration the more difficult surgery becomes and the greater the risk of this nerve root injury. So, just how high is the incidence of this risk? There is no universally accepted rate. For this reason, we have joined forces with a number of hospitals across the country to conduct statistics, the results of which will be available in the near future. The incidence is generally considered to be a few parts per thousand. It is important to note that the rate of surgical risk has little to do with individual risk, and that the one in a thousand risk rate is for the group. For a surgeon doing a thousand surgeries, if the first 999 patients do not have a nerve root injury, then the first thousand patients will not necessarily have a nerve root injury. Conversely, just because the first complication occurs, it does not mean that the next 999 patients will not have complications. Other factors related to nerve injury are the experience of the surgeon, which is also a concern. At present, most tertiary care hospitals are still very safe due to their large volume of surgery and experience. In addition, the most common injury is the dura, which is a dense membrane that surrounds the spinal cord and cauda equina, and is protected by the cerebrospinal fluid in which the spinal cord and nerves float. Dural injury leads to cerebrospinal fluid leakage. Cerebrospinal fluid leakage is not terrible and can usually be cured, and its severity is not significant. 3.Risks after surgery The main risk after surgery is infection, and there is a risk of infection in any surgery. The source of bacteria can be invaded into the body through the flow of air during surgery, or through surgical instruments. Currently, operating rooms in tertiary care hospitals are equipped with laminar flow equipment, which allows for an environment with almost no bacteria in the air. The equipment and technology for sterilization are so good that the chance of such possibility of infection by air and instruments is very low, and if there is, there will be a mass infection incident. Some patients may also have bacteria in their bodies before surgery, but they do not develop the disease because the body’s resistance is strong, and after surgery makes the body’s resistance drop and causes infection to occur. In conclusion, the risk of infection is very low and the treatment of infection is not very difficult and the cure rate is very high. The other is the breakage of the endophytic nail rod, many patients surgery to use internal fixation, currently the most widely used is the nail rod system, the purpose of nail rod fixation is to make the intervertebral body unstable after the removal of the disc temporarily fixed, while the surgery will be implanted, bone graft is the basis of intervertebral fusion. The fusion of the nail rod will be useless, and the purpose will be achieved. If there is no fusion, the nail rod will break after a long time of stress and fatigue. 4.Risk of concurrent diseases Most patients with lumbar spine diseases are elderly patients, and elderly patients are often accompanied by diseases of other organs of the body. The most common ones are coronary heart disease, hypertension, diabetes, pulmonary heart disease, osteoporosis, etc. Among them, the most risky factor affecting the surgery is the incomplete heart and lung function. The surgery itself can be very traumatic for the patient, simply because the patient is not in pain after anesthesia. This trauma can lead not only to cardiopulmonary dysfunction, but also to imbalance of the coagulation and fibrinolytic systems, as well as water-electrolyte imbalance, all of which can lead to serious complications and even life-threatening conditions. Happily, due to the advancement of technology and increased level of awareness, patients with complications of other systemic diseases are mostly safe from the dangerous period of surgery. The establishment of intensive care units (ICU) has made it possible to operate on patients who were not in a position to do so, making the risk of surgery much lower. II. Post-surgical pain Post-surgical pain is also a concern for many people. In recent years, postoperative analgesia has developed rapidly, mainly with the routine use of oral anti-inflammatory and analgesic drugs after surgery and the voluntary use of postoperative anesthesia pumps for continuous analgesia, which minimizes postoperative pain. Therefore, post-operative pain no longer bothers patients. The choice of surgery Every patient who needs surgery makes the decision to undergo surgery carefully and after a painful selection process. I believe that the mindset of each individual is important in the choice of surgery. If a patient is very concerned about the risks of surgery, he or she will not make the decision to have surgery early, while if the patient is more concerned about the condition and the harm caused by the disease, then the patient will actively request surgery. In my clinical work I often ask patients to answer the following questions: First, is your disease diagnosis clear and are you in pain? Second, is this level of pain acceptable to you now? Third, surgery is possible to relieve your pain, but of course, surgery has risks, and such risks are ………, are you willing to take these risks to eliminate your pain? In fact, the decision of surgery is mainly a dialectical relationship of the third question. However, some people do not choose to undergo surgery because of the severity of their current condition, but they are worried about whether they have to undergo surgery because they are afraid of the severity of their condition. If the second question is yes, the patient should seek help from a physician and make a final decision after an inpatient examination to assess the risks of surgery. The choice of the surgical procedure is an academic one, and the decision is not made by a single doctor, but by consensus, or by discussion among many doctors. Of course, this decision is finally made by the head of the department or by someone who can take full responsibility for the patient, and in some cases, the decision is made only after communication with the patient.