Lumbar disc herniation is a common and frequent disease. Clinically, traditional surgical treatment is often used, but some patients have poor surgical efficacy. Analysis of the main reasons for poor surgical efficacy: 1. Diagnosis of lumbar disc herniation mainly relies on a detailed history of lumbar and leg pain and clinical signs to determine the most important signs, such as straight leg raising, local pressure and radiating pain, and numbness of the calf. Some patients have to do imaging tests. Such as CT, myelography and MRI. It is irresponsible to impose surgery on a person with atypical clinical signs based solely on one of the imaging findings. In CT reading, lumbar disc bulging, herniation and prolapse should be distinguished and treated correctly. Some surveys show that the CT false positive rate is 8.13%-10.25%, and the surgery proves that it is not disc herniation, but radiculitis, malformation and tumor. 2.Differential diagnosis of lumbar and leg pain There are many diseases that produce lumbar and leg pain, and they should be differentiated from the following diseases: spinal tumor, spondylolisthesis, pyriformis syndrome, lumbar 5 transverse process hypertrophy syndrome, lumbar 3 transverse process syndrome, rheumatoid rheumatism, sacroiliac joint strain, and the lesion of the nerve itself (e.g., radiculitis, lumbosacral nerve root ganglion anomalous deformity, etc.). Especially in elderly patients, it is necessary to ask the history carefully and cooperate with the imaging examination to be able to make the identification. 3. Surgical principles (1) Selection of operation: There are three types of posterior disc surgery: window method, half laminectomy and total laminectomy. How to choose the operation should be based on age, type of herniation, etc. (2) Surgical points: it is important to maintain the stability of the posterior spinal column, and minimize the damage to the posterior spinal column structure during surgery. 4. Reasons for poor surgical outcome (1) Positioning errors and omissions: intraoperative positioning is usually done through the spinous process markers and structures specific to the lumbosacral region. (2) Nerve root and cauda equina injury; (3) Bleeding: Bleeding mainly originates from the retrovertebral venous plexus and muscle seepage. A large epidural hematoma can lead to severe early cauda equina compression and distal scar fascia. In conclusion, misdiagnosis, positioning error, nerve injury, bleeding and other factors are the main reasons affecting the poor surgical results of patients with lumbar disc herniation.