Surgical treatment of lumbar disc herniation has been performed for more than 70 years, and the classic nucleus pulposus removal has been proven by many spine surgeons to have good results. Recently, some spine surgeons have been advising patients to undergo discectomy + internal fixation implant fusion, and this is becoming more and more common. Is it necessary for the patient to undergo this internal fixation and fusion or to add an intervertebral fusion with an implant? How to understand this problem? What kind of patients need this type of surgery? Is the same procedure used for young and old patients? Is there any other surgical procedure other than internal fixation that can solve this problem? We will understand the above questions from the following aspects. First, what is the so-called classical lumbar disc nucleus pulposus removal? What is the long-term outcome? Classical lumbar disc nucleus pulposus removal is performed by removing a little bit of the bone plate (medical name: vertebral plate) covering the upper and lower lumbar discs through a small incision (about 3-4 cm long) in the traditional lumbar spine, and then removing the herniated disc nucleus pulposus tissue to end the operation. So what kind of lumbar disc herniation is this so-called classical lumbar disc nucleus pulposus surgery for? This is the question of the indications for surgery. The so-called surgical indications refer to the characteristics of the patient population for which this surgical approach is suitable. Through extensive case practice, this classical procedure is aimed at patients with simple posterior lateral herniated discs. That is, the disc herniation remains within the confines of the spinal canal. The national and international literature has demonstrated that the excellent rate of this procedure is between 80% and 95%. Moreover, the long-term results are more stable, with data from a foreign study showing the results of a minimum 10-year (10-22 years) long-term follow-up: the average improvement rate was 73.5%. Another study with a minimum follow-up of 25 years showed that the patient satisfaction rate was 90%. In a multicenter study published in 2003 by Prof. Hou Shuxun et al. in China, the excellent rates in the open group, hemi-laminectomy group and total laminectomy group were 83.8%, 77.3% and 43.5%, respectively, and the self-satisfaction rates were 100%, 100% and 91.7%, respectively, through a mean follow-up of 12.7 years (8-20 years) in 104 patients. What is the postoperative recurrence rate of classical disc nucleus pulposus removal? Just like a machine, it must continue to operate despite repair. The human disc has the same characteristics. Because it is used all the time, it is subject to fatigue, strain, and repair. The recurrence rate for classical disc surgery is generally considered to be between 6% and 15%. However, even if recurrence does not reach severe symptomatic manifestations, conservative treatment can still be continued and conservative treatment can be reoperated if it is ineffective, so the reoperation rate is not 6-15%. At present, the classical disc nucleus pulposus has been gradually replaced by the MED (discoscopic nucleus pulposus removal) procedure, which has formed a situation where the MED procedure coexists with the classical procedure, and the MED procedure has more characteristics of less trauma and more difficult technical requirements, in addition to a smaller incision than the classical procedure. However, the recurrence rate is similar to that of classical surgery. Is classical lumbar disc nucleus pulposus surgery suitable for all people? Due to the increasing awareness of lumbar disc herniation, it is now recognized that, like any other treatment, classical surgery is not perfect. As with the indications mentioned above, the classical procedure is primarily used for simple posterior lateral disc herniation. The type of disc herniation is different for each individual due to the different pathologies. In terms of the structure of the spinal canal, in addition to most postero-lateral herniations that compress the nerve roots in the spinal canal, there are also disc herniations that protrude outside the intervertebral foramen to form extremely lateral disc herniations, disc herniations with severe spinal stenosis, high disc herniations (in the thoracolumbar segment: thoracic 12-lumbar 1 segment, L1-L2 segment), disc herniations with lumbar instability, giant disc bulges, giant posterior ring dissection, revision surgery requiring removal of the articular eminence joint, etc. The above-mentioned types make it difficult to perform the classical and MED procedures, and are prone to a series of problems such as nerve damage and secondary lumbar spine damage at a later stage. Therefore, it is not appropriate to perform classical or MED surgery for the above-mentioned cases. In this case, other technical means and methods should be considered to achieve the treatment purpose. In this case, the physician often recommends that the patient undergo an internal fixation implant fusion or an interbody fusion implant fusion. The ultimate goal of this is to stabilize the spine and eliminate the movement of the intervertebral joints. Third, besides internal fixation, are there any other surgical procedures that can solve such problems? So, are there any other surgical procedures other than internal fixation? In fact, there are certain treatment procedures for the surgical treatment of lumbar disc herniation. It also includes plasma radiofrequency treatment methods, non-fusion, power fixation, and artificial disc replacement. Plasma radiofrequency treatment is aimed at patients with less pronounced herniation; while non-fusion, power fixation, and artificial disc replacement are the current popular methods. The original intent is to return a lumbar joint that may be causing stiffness to its joint motion with some degree of mobility. However, the indications are narrower than the classical procedures, and the higher cost is a disadvantage. Fourth, is the procedure the same for a young person and an older person? Although a young person and an older person are both patients with disc herniation, there may be differences in details. For example, in an older person, the degeneration of the disc is more pronounced and the stenosis of the spinal canal is more prominent due to degenerative factors. Younger people, on the other hand, are less affected by degenerative factors and may be more suitable for the mobility stabilization procedure. Therefore, the choice of surgery should also be based on different age groups and different surgical approaches. In conclusion, for the treatment of lumbar disc herniation, the aim is: to differentiate between different age groups and aim for the best curative effect; to achieve the least trauma without affecting the curative effect; not to achieve the so-called “cure” in one step; the most suitable surgery is the best surgery; to communicate fully with the surgeon before surgery, to understand one’s The most suitable operation is the best one; you should have a full communication with the surgeon before the operation to understand your condition and your operation style.