I. Lumbar disc herniation Lumbar disc herniation is one of the more common clinical lumbar disorders, is a common disease and multi-injury orthopedics. The lumbar intervertebral disc exists between the vertebrae of the lumbar spine and is a component of the lumbar spine joint, which plays a role in supporting, connecting and buffering the lumbar spine vertebrae, and its shape is like a flattened abacus bead, consisting of the nucleus pulposus, cartilage end plate and fibrous ring. When the nucleus pulposus is prolapsed due to posterior convexity or fracture of the annulus fibrosus caused by trauma or degeneration, it is called a lumbar disc herniation. Since the spinal cord passes behind the intervertebral disc, when the herniated disc compresses the spinal nerve or cauda equina nerve, causing back and leg pain or incontinence, or even paralysis, it is called lumbar disc herniation. The history of a herniated lumbar disc is often one of recurrent lower back pain and hip pain, relieved by short-term rest. The pain may be suddenly aggravated by bending over, manifesting as sudden leg pain that is more intense than lumbar pain. Leg pain that is comparable to or more severe than low back pain is radiating pain due to compression of nerve roots by the herniated nucleus pulposus. Pain due to a herniated disc is usually intermittent, worsening with activity, especially in the sitting position, relieving after rest, especially when bending, flexing the hip or knee, and worsening with exertion, sneezing, or coughing. Other symptoms of a herniated disc include decreased muscle strength and sensory abnormalities. In most patients, muscle weakness is intermittent, changes with activity, and is limited to the innervated area of the involved nerve root. Sensory abnormalities also vary and are limited to the innervation area of the involved nerve root. Numbness, decreased muscle strength, and occasional pain in the groin area or testicles in the involved leg may be associated with a central or high disc herniation. If the herniated disc is large or high, symptoms of total cauda equina compression may occur, namely numbness, decreased muscle strength, perianal pain, numbness in the perineal region and paralysis of the extensor muscles in both lower extremities. This diagnosis should be considered first in patients with sudden incontinence of urine and stool. When cauda equina syndrome or acute central disc herniation is suspected, active diagnosis and treatment should be made. The cause of lumbar disc herniation may have both internal and external causes. The internal cause is mainly degenerative changes of the lumbar disc, while the external cause is trauma, strain or overwork, etc. The degenerative changes of the intervertebral disc refer to its lack of nutritional supply and weak repair ability. In daily life, the intervertebral disc is squeezed, pulled and twisted by various aspects, which makes the nucleus pulposus, fibrous ring and cartilage end plate of the intervertebral disc gradually aging, resulting in easy rupture of the fibrous ring and causing disc protrusion. In external factors, such as long-term sitting and bumpy state, the lumbar intervertebral disc under excessive pressure, can lead to disc degeneration and protrusion; or long-term bending work, when the lumbar spine load exceeds a certain limit, can lead to rupture of the intervertebral disc fibrous ring nucleus pulposus protrusion; or when the lumbar injury, bruises, flash back, the lumbar spine nucleus pulposus moves backward, and the disc protrudes backward. Second, lumbar spinal stenosis Lumbar spinal stenosis refers to the abnormal structure of the spinal canal due to primary or secondary factors, which causes narrowing in the cavity of the spinal canal and low back pain mainly characterized by intermittent claudication. Lumbar spinal stenosis due to spinal degeneration can be caused by thickening of the vertebral plates, vertebral body osteophytes, disc herniation, spinal slippage, small joint hypertrophy or hypertrophy of the ligamentum flavum that reduces the volume of the spinal canal. Spinal stenosis can be extensive or very limited, involving only one segment or a portion of a segment. The latest nomenclature classifies locally confined stenosis into central, lateral saphenous, foraminal, and extradural types. Symptoms of all types of spinal stenosis develop insidiously and can occasionally be exacerbated by trauma or heavy physical activity. Many patients have significant changes visible on x-ray, but symptoms are mild and signs are few, and the vast majority of patients can be treated conservatively for many years. The complaints of patients with lumbar spinal stenosis vary widely. The main symptoms of lumbar spinal stenosis are chronic and recurrent back and leg pain and intermittent claudication in patients who are more likely to be middle-aged than female. The nature of the pain is soreness or burning pain, some of which may radiate to the lateral or anterior thighs, etc., mostly bilaterally, and may alternate between the left and right legs. When standing and walking, lumbar and leg pain or numbness and weakness appear, pain and limp gradually worsen, even can not continue to walk, the symptoms improve after rest, riding a bicycle without hindrance. In severe cases, it may cause urinary urgency or difficulty in urination. Some patients may develop muscle atrophy of the lower limbs, with the anterior tibialis and extensor muscles being the most obvious, hyperalgesia, dull knee or Achilles tendon reflexes, and positive straight leg raise test. However, some patients have more complaints and do not have any positive signs. Third, lumbar spine slipped dislocation of one vertebra of the lumbar spine on top of another vertebra forward or backward or lateral dislocation, resulting in compression of the cauda equina or nerve root in the spinal canal, variation in the bearing force of the lumbar spine, and a disease with lumbar pain or lower limb paralysis and pain as the main manifestation, is called lumbar spine slipped dislocation. According to the direction of dislocation, lumbar spine slippage can be divided into forward slippage, backward slippage and lateral slippage, with forward slippage being the most common in clinical practice. Lumbar spondylolisthesis can be divided into dysplastic, isthmic, degenerative, traumatic and pathological types according to the etiology. Degenerative lumbar spondylolisthesis is caused by intersegmental instability of the lumbar spine and usually occurs after the age of 50 years, and is usually accompanied by reconstruction of the articular eminence at the site of injury and lumbar spinal stenosis. After a lumbar spondylolisthesis occurs, the patient may not have any symptoms and may only be detected during a radiograph, or may have various related symptoms such as low back pain, lower extremity pain, numbness, weakness, and in severe cases, abnormal urination and defecation. Patients with more severe spondylolisthesis may have a sunken lower back, a convex abdomen, or even a shortened trunk and swaying when walking. Spondylolisthesis does not always require surgical treatment. If there is no significant aggravation of lumbar spondylolisthesis, it can be treated conservatively by limiting the patient’s activities, functional exercises of the lumbar back and abdominal muscles and other conservative treatment methods. Periodic review of lumbar spine X-rays is performed to understand the slippage. Failure of conservative treatment to relieve clinical symptoms or progressive development of lumbar spondylolisthesis are indications for surgical treatment. In general, for patients with painful spondylolisthesis, the younger the patient is, the more certain the indication for surgery and the better the surgical outcome. Fourth, other diseases 1, strain back pain The lumbar spine is heavily burdened with a wide range of activities, and the lumbar region relies on the surrounding muscles and ligaments and other soft tissues to maintain balance and coordination of activities under weight-bearing conditions. If once it exceeds its capacity, or fails to adapt to external force transmission, it can cause acute injury to these ligaments, fascia, muscles, synovial joints of the spine and other soft tissues or when chronic strain occurs, then low back pain can occur, clinically referred to as soft tissue low back pain. Lower back pain caused by various injuries is very common in clinical practice, such as vertebral accessory fractures caused by various traumatic injuries, traumatic disc herniation, acute lumbar muscle sprain, chronic lumbar muscle strain, third lumbar transverse synovial syndrome, etc. There are many factors that cause soft tissue pain in the lumbar region, which are also complex. The common clinical causative factors include injury, intrinsic factors such as anatomical variation and physique, external environmental triggering factors such as climate, secondary factors such as scar adhesions after tissue degenerative lesions, and poor posture in vitro. Non-surgical treatment is mainly based on the principles of eliminating the causes, relieving pain and spasm, dispelling inflammation and wind, coordinating balance and preventing recurrence. 2, lumbar compression fracture Most of them have a history of hip landing injury, and some elderly patients have only mild trauma due to severe osteoporosis, such as bumpy ride in a car, slipping on a flat surface, or even bending down and coughing violently can cause fracture. The pain is usually severe and fixed, and the patient often has a passive position and does not want to do any other activities; however, some elderly patients may report that the pain is not obvious due to their dull senses, but there will be obvious pain when the doctor knocks on the fracture site. Osteoporosis Osteoporosis is a group of common systemic skeletal diseases characterized by reduced bone mass and microstructural destruction of bone tissue, and is the 6th most common disease in the Bureau of Incidence, with about 200 million people worldwide suffering from this disease. Its common symptom is bone pain, especially lower back pain. The pain is mainly confined to the low back on both sides of the spine, and sometimes can be manifested as lumbosacral pain, low back hip pain, low back hip pain, posterior femoral pain, and the pain usually does not exceed the knee joint. The pain initially occurs when changing from resting state to movement state, and then gradually develops into persistent, and taking the same position for a longer period of time can aggravate the pain. However, some patients with severe osteoporosis do not have lower back pain, so the mechanism of their lower back pain is not clear. 4. Ankylosing spondylitis is a chronic inflammatory disease that mainly involves the mid-axis skeleton, and the characteristic hallmark of this disease is sacroiliac arthritis. It occurs in young people between 16 and 25 years of age, with an insidious onset and slow progression. It may be accompanied by weakness, loss of appetite, wasting and hypothermia. The pain is intermittent at first and then becomes persistent. Later, the inflammatory pain disappears and the spine becomes largely ankylosed, which can progress to severe deformity. Peripheral joint invasion is more common in female patients, with slower progression and less severe spinal deformity. 5, inflammatory diseases tuberculosis, septic bacteria and other destruction of vertebral bodies and intervertebral discs is the formation of tuberculous spondylitis, septic spondylitis or intervertebral discitis and other causes of lower back pain, in the clinical rare and more complex, mostly due to systemic symptoms and conceal the real condition. 6, tumor diseases lung cancer, breast cancer, kidney cancer, prostate cancer and other malignant tumors can occur spinal metastases, one of the multiple myeloma disease type is often seeded to the lumbar spine metastases. Intraspinal tumors of the lumbar spine and vertebral tumors such as lumbar hemangioma, giant cell tumor of bone, and myeloma also often manifest as severe back pain. With the change of medical model and the development of rehabilitation medicine, the role of psychological factors in lower back pain has received more and more attention. Studies have shown that psychological factors have a high correlation with the occurrence, development and prognosis of lower back pain, such as psychogenic pain with dysthymia or depression.