Cervical spondylosis, lumbar disc herniation, lumbar spondylolisthesis for medical purposes, are “degenerative disorders”, also called “degenerative changes” or “degeneration”. To put it bluntly, it is “old + tired”, about the same as the hair turns gray, skin wrinkles. Aging is a human condition, and it starts after the age of 20. This is true for everyone, and it is true for everyone by age 90. The following misconceptions are common among my patients – two extremes: one is the fear of surgery and the resolute refusal of surgery, and the other is the blind faith in the “power” of surgery and the hope that surgery will solve the problem once and for all. This short article will mainly analyze. The causes of cervical spondylosis, lumbar disc herniation and lumbar spondylolisthesis are aging + fatigue – fatigue is not physical labor, but long hours of desk work, driving, sitting in a car, housework, computers, playing cards, knitting sweaters, playing games and so on. For example, in recent years, there are more and more college students, middle school students, and even elementary school students who have early lumbar disc herniation because of poor study posture and playing computer games. (Jiang Liang of the North Medical College original citation, please specify the source) The results of the Nordic census showed that 9% of adolescents between the ages of 14 and 18 have a “black disc” (black disc – see picture) – a reflection of disc degeneration. –This reflects disc degeneration (i.e., aging). This suggests that the discs are aging much earlier than we previously thought. (Original by Jiang Liang of Beihang Medical College.) The advent of advanced gaming consoles such as the iPad will exacerbate this situation. Surgery is unlikely to address the underlying factor of the disease – “aging + strain”. In other words, surgery cannot cure “degeneration”. The purpose of surgery is to solve two problems: 1) nerve compression (surgery can release the nerve compression); 2) inadequate spinal support (surgical fusion of bone graft + internal fixation – that is, “nail”) Even if surgery, it is not possible to solve the root of the problem “aging + strain”. Because the cause of this disease can not be cured now, after 2 centuries may be OK. If you can really cure it, you can “live forever” + “labor forever”. The following is an example of lumbar intervertebral disc herniation surgery to further explain. 1, the most classic lumbar disc herniation surgery is “open window method lumbar discectomy”. This surgery is to remove the herniated disc and release the nerve compression. Generally, 70% of the symptoms are relieved after surgery, and the recurrence rate is 5-10% after surgery. The incision is usually 4-5 cm (varies from person to person, e.g. long wound for fat people), and the patient is discharged from the hospital 1-2 days after the surgery. The surgery is done under direct vision and the surgical risk is low. Because this surgery removes only 10-20% of the “bad” discs, the relatively “good” discs remain – only relatively. The possibility of recurrence after surgery is 5-10% if you continue to live and work in the same way as before. 2. The second most common surgery is “nailing”. Generally the surgery is larger, with more complications and slower recovery. For cases where it is necessary, it is a “good solution without a solution”. Even after stapling, the “fixed” segment will be fine, but the adjacent segments will continue to deteriorate, and there is still a 5-10% chance that the problem will recur. （3. “Minimally invasive” is a hot topic today, and there are many different types, even in Europe and the United States, it is still an experimental stage and needs to be improved. (1) Radiofrequency, ozone, laser – 1~2cm wound, for patients with mild disease. The general goal is to reduce the size of the aging disc, decompression effect is indirect, it is impossible to stop the “degeneration”. (2) Intervertebral discoscopy – 2 cm wound, the operation inside the body is like an incision operation, only the surface wound is reduced. Foreign spinal degeneration surgery is called “buy time surgery” (buy time surgery) – buy a period of time, “broken” to buy again. Data from the UK show that patients with lumbar disc herniation have a similar physical condition after 5 years in the surgical and conservative groups – the difference is that patients who have surgery recover quickly and are able to return to work as soon as possible. In other words, if you can tolerate the symptoms, you can be conservative first; if the symptoms are too severe to tolerate, you must have surgery as soon as possible. In the following cases, surgery must be performed as soon as possible or even in an emergency: foot drop (inability to lift the ankle), damage to the cauda equina nerve (inability to control urination and defecation, numbness around the anus), significant muscle weakness, and significant muscle atrophy. When numbness, weakness, unstable walking, and inflexible hands of the extremities appear, early surgery should be performed. （In addition, if you don’t have surgery, you need to protect yourself from trauma or exertion, which may lead to deterioration of your condition. Of course, surgery is a “good solution without a solution”, also known as the “art of regret”. Surgery is similar to putting out a fire. It is impossible to cure the fire, but it is possible to put out the fire again. When symptoms recur after surgery, it is usually because the patient is again strained or cold. Most of them are the result of long-term inattention to “sitting, movement and back exercise”. In most cases, the symptoms can be relieved by themselves after 1-2 weeks of good bed rest. In a small number of patients, the symptoms persist, and surgery can be repeated. However, the risk of surgery and trauma will be greater than the first surgery. All in all, even after surgery, it is still important to protect yourself: pay attention to your posture, move around regularly, and strengthen your low back muscles. This self-protection should be lifelong. It cannot be temporary.