If lumbar disc herniation with cauda equina nerve injury is not diagnosed and treated in time, the consequences of its lesion development are very serious, often leading to urinary and faecal and sexual dysfunction and causing lifelong pain to patients. Among the 224 cases of lumbar disc herniation treated by our hospital from June 1997 to October 2007, 49 cases (21.8%) were combined with cauda equina nerve injury, and the analysis and discussion are as follows according to the follow-up effect of this group. 1, clinical data The 49 cases in this group, 31 men and 18 women; age 25-61 years old, average 43 years old, the shortest duration of the disease 2d, the longest 10 years. Herniated disc sites: 5 cases of L2,3, 6 cases of L3,4, 17 cases of L4,5, 11 cases of L5S1, 10 cases of L4,5, L5S1 double interval protrusion. Medical history and precipitating factors: 36 cases had a history of chronic recurrent low back and leg pain, and 13 cases had sudden onset without previous symptoms. The shortest time between the appearance of nerve root and cauda equina injury and surgery was 8 h and the longest time was 6 months. Thirty-one cases had a history of chronic low back pain without obvious causative factors, eight cases had lumbar sprain, three cases occurred during massage, six cases occurred during traction therapy, and one case after a fall. Clinical manifestations: 49 cases had low back pain and lower limb radiating pain, 20 cases with double lower limb pain and 29 cases with single lower limb pain. There were 5 cases of fecal incontinence and saddle area numbness, 15 cases of constipation and saddle area numbness, 11 cases of constipation and urinary retention, 18 cases of partial fecal incontinence and saddle area numbness; 28 cases of significant atrophy of calf muscles, among which 11 male patients had abnormal penile erection, and 2 cases had abnormal penile erection after prolonged standing and sitting. Auxiliary examination: X-ray films showed that the physiological curvature of the lumbar spine disappeared to different degrees and the corresponding intervertebral space became narrower. MRI examination showed that the dural sac was compressed, the nucleus pulposus of the disc prolapsed in the spinal canal in 6 cases, and the vertebral body There was bone redundancy formation. 2, surgical methods: 5 cases of total laminectomy (including 2 cases with internal fixation), 9 cases of hemilartebral laminectomy, 35 cases of intervertebral disc removal with an interlaminar window, and lateral saphenous fossa enlargement in cases of lateral saphenous fossa stenosis, and resection of hypertrophy of the ligamentum flavum. Intraoperatively, the dural sac was found to be compressed, flattened, partially bruised, partially adhered to the nucleus pulposus, and the compressed nerve roots were edematous and thickened with increased tension. 37 cases of herniated discs were not ruptured, 12 cases of ruptured fibrous rings and free nucleus pulposus, 7 cases of herniated nucleus pulposus with calcification requiring goose brow chiseling, and 14 cases of hypertrophy of the ligamentum flavum and adhesion to the dura. 3. Results The group was followed up for 6 to 48 months, with an average of 27 months. Referring to Zhang Fengshan’s efficacy evaluation criteria and methods: excellent, lumbar and leg pain, numbness of both lower limbs and saddle area disappeared, sphincter function and lower limb function were basically normal; good, lumbar and leg pain, numbness of both lower limbs basically disappeared, the function of two stools recovered significantly, but there were still abnormal sensations, most of the lower limb muscle strength recovered, work life was basically normal; may, lumbar and leg pain basically disappeared, saddle area still numb, lower limb muscle strength partially recovered, walking still had difficulties The gait was abnormal, and the patients could take care of themselves; poorly, the low back pain was relieved, the numbness in the saddle area, the sphincter function was not improved, the muscle strength of the lower limbs was partially recovered, and they still needed to hold the crutches for walking. In this group, 7 cases were excellent, 29 cases were good, 8 cases were acceptable, and 5 cases were poor (the lumbar pain and lower limb radiating pain basically disappeared in these 5 cases after surgery, 2 cases recovered the function of urinary and fecal, but the saddle area was numb and the penis could not be erected; 2 cases showed partial incontinence of urinary and fecal, saddle area was numb and the penis could not be erected; 1 case had unilateral lower limb muscle atrophy, urinary and fecal incontinence and saddle area was numb). 4. Discussion Lumbar disc herniation is one of the common and frequent diseases in orthopedics, and lumbar disc herniation combined with cauda equina injury is not rare clinically, mainly in the lower lumbar spine, commonly in central type lumbar disc herniation. The diagnosis is not difficult when combined with medical history, physical examination and imaging examination, but sometimes the history and physical examination are not detailed, which may easily lead to missed diagnosis or delayed treatment. The consequences are also very serious. In addition to the clinical symptoms and signs of lumbar disc herniation, this complication is also characterized by a combination of saddle sensory disorder and sphincter dysfunction, which predisposes men to functional impotence and women to urinary retention or pseudo-incontinence. The pathogenesis of lumbar disc herniation combined with cauda equina injury is generally considered to be related to the herniated intravertebral canal occupancy and mechanical compression affecting cerebrospinal fluid circulation, resulting in cauda equina congestion, edema and impaired blood supply. Trauma and large weight traction and inappropriate massage are mostly predisposing factors for this disease. Whether acute or chronic lumbar disc herniation with cauda equina injury, once the diagnosis is clear, early surgical treatment is required; otherwise, if the treatment is too late, it will be difficult to recover the nerve function, with the aim of removing the cause, relieving the compression, and creating a good environment for the recovery of cauda equina as soon as possible. The postoperative efficacy depends on two main aspects: ① the degree of compression of the cauda equina; ② the timing and method of surgery. The earlier the surgery, the faster the postoperative recovery of nerve function. The cauda equina nerve is more complex than the lower extremity nerves and has a finer function, so the cauda equina nerve is more difficult to recover from the same compression or injury. It is generally believed that the nerve edema of the cauda equina nerve reaches its peak in 24-48 h. The longer the compression time, the heavier the edema, and if the compression is not released in time, the nerve function will not be fully recovered. Most of the patients in this group were given surgery within 12 h after clear diagnosis. The choice of surgical method is very important for the postoperative effect. Two main aspects should be considered when choosing the surgical method: first, the decompression should be complete, and second, the stability of the spine should be preserved as much as possible. This group of cases shows that the use of unilateral or bilateral interlaminar decompression and enlargement of the spinal canal can fully achieve the purpose of decompression on the basis of preserving the stability of the spine, and the process of decompression should pay attention to the clean removal of the intervertebral disc, especially the free intervertebral disc tissue, and the expansion of the lateral saphenous fossa stenosis, so that the cauda equina and nerve roots can be completely released, creating favorable conditions for nerve recovery. In clinical practice, we should pay high attention and be alert when patients have saddle area numbness and urinary and fecal dysfunction, and strive for early diagnosis and surgical treatment.