Analysis of the causes of misdiagnosis 1, to avoid preconceptions. Because most of the doctors of acupuncture and massage in primary hospitals are graduates of acupuncture and massage or orthopedic injury in Chinese medical schools, they are more expert in the specialty level; especially for neck and lumbar pain patients, as long as they casually ask, they will know the cause, and then give treatment, which may lead to misdiagnosis and mistreatment. As a specialist, to expand the knowledge and improve the ability to identify tumors is also an urgent task. With the development of society and the refinement of medical division of labor, the spectrum of diseases in acupuncture, moxibustion and massage becomes narrower, and the limitation of knowledge is prominent, leading to preconceptions about many diseases and ignoring the existence of other diseases. As people’s legal awareness increases, reducing misdiagnosis to avoid disputes is also in front of us, such as neck, waist and leg pain patients who have poor results after regular treatment should ask a few more whys, deny themselves and reacquaint themselves so that they can be diagnosed. 2, careful observation and repeated examination. As it is not easy to distinguish patients with neck and low back pain from intravertebral tumor in early stage, because crestal medullary tumor disease in early stage mostly shows symptoms of radicular irritation, and its pain location, degree and nature are very similar to discogenic low back and leg pain, and crestal medullary tumor is mostly benign and develops slowly, it must be carefully and repeatedly examined, and when muscle strength and sensory loss are inconsistent with nerve distribution, it can mostly be further examined and the diagnosis can be confirmed. 3. Over-reliance on CT and X-ray films, especially when there is a history of cervical and lumbar pain in the past, the diagnosis is made hastily based on the previous CT films and X-ray films only, without carefully analyzing the patient’s current condition, symptoms and signs and clinical manifestations. In order to prevent false negatives and false positives, one should not just see the trees but not the forest, and only see prominence or hyperplasia or laxity. And failure to further examination. Preventive measures 1, careful and careful history taking. For example, there is a male patient in this group, 43 years old, admitted to the hospital for 3 weeks because of lumbar leg pain for 1 year and left lower limb pain. 3 weeks ago there was a history of lumbar sprain, a year ago there was a history of lumbar disc herniation in the outside hospital, and a lumbar CT scan was done in the outside hospital, this admission was initially diagnosed as lumbar disc herniation, and L45, L5SI disc herniation was also seen on the admission CT film, and after regular treatment for lumbar disc herniation, the symptoms started to After regular treatment for lumbar disc herniation, the symptoms were relieved at first, but a week later the pain increased and was mainly at night. The patient’s medical history was carefully followed up again, and after communication with the patient’s family, it was learned that the patient had undergone rectal cancer surgery 10 years ago and had a history of artificial anus surgery. A week later, MRI and ECT scan from a higher-level hospital were performed, suggesting destruction of the L5 and SI vertebrae. He was transferred to a provincial hospital for treatment and later followed up by telephone, and rectal cancer L5 and S1 vertebral metastases were considered. If careful history taking was repeated at the time of admission, misdiagnosis and mistreatment might also be avoided. 2.Comprehensive and meticulous physical examination. In addition to specialist examination, the whole body condition of patients with neck and back pain should not be neglected. For example, a female patient, 51 years old, was admitted to the hospital with low back pain with right lower limb pain and numbness aggravated for four years and one month, CT scan suggested L45 disc protrusion, and was treated with acupuncture, moxibustion, massage and comprehensive treatment, the pain was relieved and discharged. Six months later, the symptoms of lumbar and leg pain were aggravated by a sprain, and another CT scan was performed, suggesting a herniated L45 disc, and L45 disc ozone plus collagenase ablation was performed, and the pain was relieved in three months after the operation, but the numbness of the right lower extremity was not reduced, and walking instability, weakness of the dorsal extension of the bunion, and loss of sensation in the right lower extremity appeared. He was later transferred to a provincial hospital for MRI of the thoracic spine, which showed: epidural neurofibroma of the thoracic 5 and 6, and was cured by surgical treatment. The patient was carefully examined and found that the right medial thigh and medial calf superficial sensation was also diminished. Therefore, it is necessary to combine point and surface, to have a holistic concept and to understand the condition comprehensively. 3. necessary auxiliary examination is another key issue. x-ray and CT scan play an important role in the diagnosis of cervical and lumbar pain. mri has a big advantage not only in localization and characterization. Crest x-ray is a necessary routine examination. Some patients have had CT of intervertebral disc at outside hospital when they visited the clinic and considered as disc herniation. ct scan only pays attention to intervertebral disc layer and does not scan vertebral body, while x-ray cannot distinguish early crestal tumor. It cannot be considered that a normal x-ray can exclude the possibility of tumor. For example, a patient was diagnosed with lumbar disc herniation in a foreign hospital only 3 years ago and got better after treatment. 1 month ago, he developed lumbar pain and pain in both lower limbs due to cold, and a CT scan was performed to see a herniated disc at L45, which was treated as lumbar disc herniation for a week with poor results and limited walking, weakness and sensory loss. Later, MRI of thoracic spine was performed, suggesting an occupancy in the thoracic spinal canal, and the patient was transferred to a higher level hospital. Follow-up by telephone was an epidural nerve sheath tumor of the thoracic spine. Therefore, further examination of the thoracic spine, cervical spine, cranium, etc. is necessary, as well as electrocardiogram, hepatobiliary, pancreatic and spleen, uterine adnexal, prostatic-urinary ultrasound, gastroscopy, four rheumatic items in laboratory tests, and alkaline phosphatase enzymology are necessary. Whenever the treatment is ineffective, self-denial should be used to doubt the original diagnosis, further examination, repeated examination and re-recognition to avoid misdiagnosis and improve medical treatment for the benefit of patients. 4, standardize the clinical diagnosis mode, will be more conducive to reduce misdiagnosis. According to the characteristics of the medical history to analyze the disease inside and outside the spinal canal, (1) the tension in the upright or bending state can exacerbate the aseptic inflammation of the soft tissue in the nerve sheath, which is generally considered to be a herniated disc or thickened ligamentum flavum. (2) Increased abdominal pressure, such as defecation, coughing and sneezing, has an effect on pain, mostly from intraspinal lesions, and less from extra-spinal soft tissue injuries. (3) One day pain changes, morning lumbar and leg pain is obvious, even in the early morning pain, and can not lie down, must get up and move to relieve, mostly extradural soft tissue injury disease. In the case of intra-vertebral canal lesions, the pain is mostly painless or mild in the morning. (4) Lower limb pain. Pain in the lower extremity can be caused by stimulation of the dural crest and ligamentum flavum areas innervated by the nerves in the spinal canal, as well as radiating pain caused by nerve root compression, or radiating pain caused by damage to the muscles and ligaments outside the spinal canal and stimulation of the nerve trunk branches. However, in terms of lower extremity radiating pain, intravertebral lesions appear mostly in single segment and involve the distal nerve sensory distribution area of the lower extremity, with a high chance of both pain and numbness, while lower extremity radiating pain from extravertebral soft tissue damage generally does not exceed the knee, and sensory loss in the distal part of the lower extremity (foot) is less common, with the painful part of the lower extremity being more ambiguous. (5) Evolutionary features of the disease course: extravertebral tissue damage disease can come on suddenly and can usually be relieved within a short period of time; while low back pain caused by intravertebral lesions often comes on frequently. (6) Cauda equina damage is a characteristic of intradural lesions. Such as spinal stenosis, huge disc herniation, intra-vertebral tumor, etc. If low back pain continues to develop and worsen, the presence of spinal tumor should be highly suspected. (7) Involvement pain. Primary abdominal or pelvic organ lesions that trigger superficial pain in one or several places in the lumbar back and sacral region, along with the presence of segmental lumbar reflex muscle spasms, should be alerted. For example, ovarian and uterine lesions in gynecology, urological stones, nephritis, prostate and rectal lesions. Only by improving one’s diagnostic level and increasing responsibility can one reduce misdiagnosis.