Let’s start with a few questions: Is a herniated disc the same thing as a lumbar disc herniation? Can a diagnosis of lumbar disc herniation be made by low back pain + thigh pain + lumbar disc herniation? Is bed rest necessary for conservative treatment of lumbar disc herniation? Is surgery necessary for lumbar disc herniation with neurogenic signs and symptoms? If you are sure about all these questions, there is really no need to read on in the following. A herniated disc in the lumbar spine A herniated disc is a rupture of the fibrous annulus of the intervertebral disc, with the nucleus pulposus tissue protruding (or prolapsing) from the site of the rupture into the posterior or spinal canal. This is really just a pathological change, or imaging manifestation, almost an indispensable change in the human aging process, just like the appearance of wrinkles on the face and graying of the hair, which is not a disease. According to the literature, there is a high incidence of lumbar disc herniation in asymptomatic people. One study performed MRI scans on 102 asymptomatic volunteers, aged 14-82 years with a mean of 46.3 years, and found rates of disc herniation, annulus fibrosus tears, and nucleus pulposus degeneration of 81.4%, 76.1%, and 75.8%, respectively. A study published in the JBJS showed that more than 20% of asymptomatic volunteers under the age of 60 had disc herniation, and a study in Spine also showed that 40% of asymptomatic volunteers under the age of 30 had disc degeneration, rising to 90% of volunteers aged 50-55. Additional long-term follow-up studies have found no correlation between the presence of herniated discs in these volunteers and the subsequent presence and duration of low back pain. Lumbar disc herniation, on the other hand, is a clinical syndrome in which a herniated lumbar disc causes irritation or compression of the adjacent spinal nerve roots, resulting in a series of symptoms such as low back pain, numbness and pain in one or both lower extremities. In fact, in English literature and monographs, there is no such term as lumbar disc herniation, but the terms “sciatica” and “lumbar disk herniation” appear very frequently in the relevant literature, and in many contexts are probably similar to the Chinese term “lumbar intervertebral disc herniation In many contexts, it is probably similar to the Chinese term “lumbar disc herniation”. Of course, the expression “asymptomatic lumbar disc herniation” is also used. Professor McCulloch was a landmark figure in the study of lumbar degenerative disease, and his diagnostic criteria have been used to date: 1. leg pain greater than lumbar pain, mainly confined to the sciatic or femoral innervation zone; 2. abnormal sensation in the dermatomes; 3. positive straight leg raise test with an angle less than 50% of normal, or positive straight leg raise test on the healthy side; 4. muscle atrophy, weakness, hypoesthesia 2 of the 4 items, such as muscle atrophy, weakness, hypoesthesia and weakened tendon reflexes; 5. Imaging features consistent with clinical manifestations. According to the above diagnostic criteria and the pathological features of lumbar disc herniation, lumbar disc herniation must not only have the pathological changes of lumbar disc herniation (imaging manifestations), but also must have clinical manifestations of damage to the corresponding nerve structures, pain and numbness, etc. with radicular distribution. Therefore, even if there is an obvious lumbar disc herniation on imaging and there is also regional pain in the lumbar region, buttocks or thighs, etc., the diagnosis of lumbar disc herniation is questionable if there is no pattern of radicular distribution of nerves. Must I be bedridden for conservative treatment of lumbar disc herniation? Most of the domestic monographs, Chinese literature, and even textbooks advocate strict bed rest for conservative treatment of lumbar disc herniation. However, a search of the English literature suggests otherwise. Spine, the most authoritative journal in spine surgery, has published a Cochrane systematic review with the highest level of evidence-based medicine, concluding that patients with acute low back pain are advised to obtain less benefit (pain, functional recovery) from bed rest than from continuing to maintain daily activities; and that there is little difference between bed rest and maintaining activity in patients with lumbar disc herniation. There is a large body of literature that is consistent with these views and few studies have been reported that advocate strict bed rest. This shows that bed rest is not necessary, and if the patient’s pain and dysfunction are not so severe that it is difficult to walk, there is no need to artificially restrict their activities and strictly require bed rest. There is no uniform opinion on the indications for surgery for lumbar disc herniation. But should surgery be performed if there are typical neurological symptoms and signs? From the point of view of the high-quality literature such as NEJM and BMJ, surgery can be considered for patients with clearly diagnosed lumbar disc herniation (1) with cauda equina syndrome or acute severe local paresis or progressive worsening of paresis; (2) with intractable radicular pain (unrelieved by morphine) or unrelieved by 6-8 (12) weeks of systematic conservative treatment. In general, surgery is safe and has a lower rate of complications, and symptomatic improvement is usually faster and greater with surgery; however, non-surgical procedures are also safe, unless cauda equina syndrome is present as well as progressive nerve damage at home, and non-surgical treatment is chosen for a better outcome in the end. This means that most discectomies can be avoided and without any long-term damage. If their symptoms are intolerable, surgical treatment may be considered if early recovery is desired. For patients with a lumbar disc herniation with non-specific back pain, please do not cut the disc in the name of lumbar disc herniation.