Recently, I have been asked by many patients, “Doctor, I have been suffering from low back pain for many years, and recently my legs have been numb, is this condition compressing the nerve? Do I have to have surgery? If I don’t have surgery, will I be paralyzed in the future? To answer this question, it is really not clear in one or two sentences, first of all, let us analyze what are the most common diseases that cause back pain and leg numbness? The most common is lumbar disc herniation, human beings from the age of 18, the lumbar intervertebral disc began to continue to degenerate, 95% of lumbar disc herniation occurs in L4-5, L5-S1 intervertebral disc, the typical performance of lumbar pain, and along the thigh to calf radiation. There are currently several views on the main causes of pain due to nerve compression by herniated discs – mechanical compression leads to inflammation and edema of the nerve roots, causing neuralgia. -The nerve roots are irritated by the nucleus pulposus tissue contained in the degenerated disc, causing neuralgia. The nerve tissue can initially adapt to and tolerate the stenosis, but when the nerve tolerance limit is exceeded, symptoms can occur. -The cause of lumbosacral nerve root pain due to lumbar spinal stenosis is more complex, mainly due to the action of the dorsal root ganglion and also involving the activation of injury receptors. Then there is degenerative lumbar spondylolisthesis, which is also common in the elderly. When the patient extends the back, the posteriorly displaced vertebrae and discs increase the pressure on the lumbar spinal canal, resulting in the manifestation of lumbar spinal stenosis, which also causes pain in the back and legs. Seeing this, you will find that there are many causes of lumbar pain and leg numbness, so do they all have to be operated? The answer is of course no – 80%-90% of patients with lumbar disc herniation can be cured by non-surgical treatment, mainly for young ones, with first attack and short duration of disease, without serious prominence in imaging, this case of back and leg pain is mainly nerve irritation, through standardized anti-inflammatory and analgesic and other symptomatic treatment, the symptoms can be significantly relieved after rest. -Lumbar spinal stenosis, because of the generally long history, conservative treatment can alleviate the symptoms of nerve irritation but cannot improve the lumbar spinal stenosis, and it is often easy to relapse after treatment. -Degenerative lumbar spondylolisthesis, due to the loss of stability between the vertebrae, conservative treatment is generally ineffective and the condition tends to gradually worsen. Some patients are often afraid of surgery, so will they be paralyzed in the future without surgery? When the nerve is compressed for a long time, nerve degeneration and necrosis will occur, and then there will be permanent loss of function of the corresponding innervation, such as inability to lift the foot, inability to pedal, weakness of knee extension, claudication, incontinence, etc. Although there is no precise clinical definition of how long the compression will last, when conservative treatment for low back pain is ineffective and the condition gradually worsens, it may really be necessary to consider “surgery”. When conservative treatment does not work and the condition gradually worsens, it may be necessary to consider “surgery”.