Definition】 It is a syndrome caused by lumbar disc degeneration, rupture of the annulus fibrosus and herniation of the nucleus pulposus to compress or stimulate the nerve root or cauda equina. The incidence of lumbar 4-5 and lumbar 5-sacral 1 is the highest, accounting for about 90%~96%. Diagnosis] I. Clinical manifestations (a) Typical manifestations 1. degenerative disc degeneration, trauma-induced acute attacks. Prevalent in 20~50 years old, more men than women. 2, low back pain, accompanied by unilateral radiated lower limb pain, symptoms are aggravated by activity or exertion, and alleviated by bed rest. A small number of patients may have bilateral sciatica. Sensory impairment, numbness, mostly in the lateral and posterior lateral calf and the outer edge of the foot. Weakness and inflexible movement of the affected toes. Patients with central disc herniation may have urinary and fecal disorders and numbness in the saddle area. Some patients may develop coldness or edema in the lower extremities, which may be related to sympathetic nerve stimulation. (ii) Physical signs of lumbar lateral herniation, shallow anterior protrusion, deep pressure pain next to the spinous process of the lesion gap and radiation to the lower limbs, and limitation of lumbar movement. Muscle atrophy may appear in the affected limbs. In the case of lumbar 5 nerve root involvement, the strength of the ankle and toe dorsiflexion muscles is reduced, and in the case of sacral 1 nerve root involvement, the strength of the toe and foot plantarflexion muscles is reduced. For lumbar 4-5 and lumbar 5-sacral 1 disc herniation, straight leg raising test and strengthening test are positive, knee reflex and ankle reflex are weak; for lumbar 3-4 disc herniation, femoral nerve pulling test is positive. Auxiliary examination (a) X-ray examination: 1. Plain film: Lateral X-ray of lumbar spine can be seen as lateral protrusion and physiological bending of lumbar spine, narrowing of vertebral space. The presence of deformities can be understood. Dynamic lateral film can understand the stability of the lumbar spine. 2, myelogram: the herniated area can be seen as obstruction or nerve root deficiency, and this examination has heavy complications that should be strictly controlled indications. (b) CT, MRICT can show the bony spinal canal morphology, the degree of thickening of the ligamentum flavum and the relationship between the size and direction of the herniated disc and the nerve roots, which has a greater diagnostic value. For lateral lesions such as nerve root canal stenosis and lateral disc herniation, it is clearer than myelography. The images are easier to distinguish if myelography, i.e., CTM, is added. MRI has high resolution for soft tissues, and in addition to understanding the strength of the herniated disc and nerve root compression, it can also provide a comprehensive view of the degeneration of each lumbar disc and exclude occupying lesions in the spinal canal. (iii) Electromyography assists in determining the extent and degree of nerve damage and is optional. (iv) Laboratory tests as a preparation before surgery. (c) Diagnostic criteria (a) Low back pain with unilateral radiating lower limb pain, sensory disturbance, numbness, mostly in the lateral and posterior lateral calf and lateral edge of the foot. Weakness, inflexible toe movement on the affected side. Straight leg raise test and strengthening test are positive. The affected limb has decreased sensation in the lateral aspect of the thigh and calf and the foot. Preliminary diagnosis is made based on the above manifestations. (b) The above (a) with typical X-ray imaging or CT or MRI performance to determine the diagnosis. Treatment】 I. Non-surgical treatment. (a) Emphasize bed rest, get up and move around with a lumbar girth after 3 weeks, and strengthen the exercise of low back muscles. (2) Traction, physiotherapy and massage. (3) Drug therapy and closure therapy. (2) Intervertebral disc myeloplasty includes plasma radiofrequency myeloplasty, laser vaporization, intravertebral disc electrothermal therapy, etc. Indications: 1. persistent lower back pain with a duration of more than 6 months; 2. ineffective non-surgical treatment for more than 6 months; 3. no positive signs in neurological examination; 4. negative straight leg raising test; 5. no obvious nerve root compression in MRI. Contraindications: disc prolapse, free nucleus pulposus, and lateral saphenous fossa stenosis. Minimally invasive discoscopic surgery mainly includes posterior posterolateral discoscopy and posterior discoscopy, the selection of indications is more strict than traditional surgery, and the best indication is mild herniation of the posterolateral type in a single segment. Indications for surgical treatment: 1. 3-6 months of non-surgical treatment is ineffective; 2. long history of disease, recurrent attacks and affect work and life; 3. short duration of disease but heavy symptoms, pain medication can not relieve; 4. central disc herniation with cauda equina nerve compression; 5. with lumbar spinal stenosis or instability; 6. imaging examination reveals serious disc degeneration and huge herniation The decision of the surgical procedure should be based on the herniated disc. The decision of surgical modality should be based on the size of the herniation, whether it is combined with spinal stenosis, lumbar instability, and the patient’s general condition. It includes open window removal, half or full laminectomy and nucleus pulposus removal, lumbar fusion, etc. In recent years, there is a combination of artificial nucleus pulposus replacement or non-fusion fixation, but there is a big controversy. Efficacy criteria】 I. Cure The symptoms disappear, the surgical opening heals, and the function is perfect or basically restored. Improvement Symptoms are reduced and function is improved. No symptom reduction, no functional recovery.