I have been trying to package up all the surgical questions for degenerative lumbar spine disease and answer them. But today a friend came to the clinic with a simple lumbar disc herniation in the lower lumbar spine in a young man who was advised by some specialists to have the disc removed and fused and fixed or the disc replaced, which seems to be quite common. Therefore it is better to talk about the surgery of lumbar disc herniation separately. First of all, it should be clear that most (about 80%) lumbar disc herniations do not require surgical treatment and that conservative treatment is generally more effective. The main methods of conservative treatment include drugs (analgesics, muscle relaxants, decongestants, or neurotrophic agents), physical therapy, acupuncture, traction, manipulation, functional exercise, rest, etc. Surgery is required only in cases of nerve root paralysis or damage and in cases where systematic conservative treatment is ineffective or inefficient and recurrent. Laminar decompression and nucleus pulposus removal remains the classic, standard procedure for lumbar disc herniation and is an open, minimally invasive procedure for the vast majority of disc herniations. In recent years, microscopic surgery has been widely performed in various places, and the advantages are obvious, but it requires strict indications for surgery and a longer period of rigorous training for the surgeon. There is a trend toward “generalization” and “expansion” for reasons that are not easy to explain. A few years ago, EuroSpine published several reports with a large sample of more than 10 years of follow-up. The results of simple open window decompression and nucleus pulposus surgery were very positive, and the surgery was less invasive, shorter and less expensive. On the contrary, the so-called disc replacement nowadays has not yet experienced the test of time and is costly and more surgical. The key point is that the purpose of these measures such as avoiding lumbar instability, or preventing degeneration of adjacent segments is only theoretical and there is no solid evidence. The additional surgery also brings with it corresponding problems, and may be somewhat unnecessarily costly or not worthwhile. Fortunately, the fad for lumbar disc replacement has passed, and responsible physicians generally do not recommend this procedure. Some problems cannot be prevented and cannot be prevented, such as degeneration, the trend is inevitable, only the degree and speed is different, and there are many factors that cause this difference. Another example is that death is an inevitable outcome for everyone, but it cannot be prevented. Therefore the vast majority of cases of simple lumbar disc herniation do not require additional fusion fixation or disc replacement surgery. However, for this disease, open or microscopic nucleus pulposus removal is not the ultimate treatment, and some cases may require reoperation for recurrence, lumbar degenerative instability or degenerative stenosis possibly, and in general reoperation mostly requires fusion fixation. In any case, depending on the condition, stepwise treatment by disc herniation is appropriate for the vast majority of cases. In cases where instability already exists in the lumbar spine, or where the tendency or signs of instability are already very evident (mostly in the elderly), reconstruction of lumbar stability by means of fixation and fusion needs to be considered only after the disc has been removed. Note: Recently, a number of cases of disc prolapse with severe nerve root damage have been admitted, and a significant number of patients do not understand the treatment. It should be emphasized that once there is clear nerve root damage, it is recommended to operate as soon as possible, as conservative treatment is difficult to have a clear effect. The earlier the surgery, the greater the chance of recovery of nerve function, and the later the surgical decompression, the less hope for recovery. Although surgery itself does not directly improve nerve function, it does create the necessary conditions for recovery or improvement of nerve function.