It should be said that 80% to 90% of patients with lumbar disc herniation can get significant relief from their symptoms after conservative treatment. However, there are still some patients who, after a short period of conservative treatment, are advised by their physicians to “operate”, why is this? Whether a patient with lumbar herniation needs surgery or not depends not only on the size of the herniation shown by imaging, but also on the severity of the symptoms and the impact on normal life and the effectiveness of conservative treatment. Generally speaking, patients with lumbar disc herniation should first be treated conservatively, but surgery should be considered if one of the following conditions occurs: (1) Severe pain that seriously affects the quality of life: Some patients with severe pain may be cured after a period of conservative treatment. However, it is irresponsible for patients to endure long periods of extreme pain, and sometimes it is psychologically difficult for them to accept it. It is also difficult to predict whether conservative treatment is always effective. Therefore, for this group of patients, surgery should be considered for treatment as early as possible. (2) Patients for whom conservative treatment is not effective: Patients who have undergone 6 months of conservative treatment under the regular guidance of a physician without any or little effect should be considered for surgery. The observation period for conservative treatment varies from person to person, and in some cases, it is reasonable to operate as soon as possible for patients who have been on conservative treatment for less than 6 months, depending on the requirements of their condition. (3) Patients with obvious neurological symptoms: The appearance of lower limb muscle atrophy, foot drop, and urinary and fecal dysfunction means that the patient has very serious neurological dysfunction and should be operated on as soon as possible to relieve the compression of the nerve, otherwise, the neurological function cannot be effectively recovered or not recovered at all. (4) Recurrent symptoms: Some patients’ symptoms may disappear after a period of conservative treatment, but they may appear again soon afterwards. The triggers are often cold, exertion, or cumulative strain. For these patients, symptoms recur again and again, and it is obvious that conservative treatment cannot solve the problem, so surgical treatment should be used. Although surgical treatment cannot guarantee a permanent solution, the recurrence rate after surgical treatment is much lower than that after conservative treatment. (5) In addition, patients with a central disc herniation or disc prolapse into the spinal canal suggested by imaging should be treated with surgery early. Because these types of disc herniation are more severe, delaying surgery often leads to serious consequences.