The question of whether or not to have lumbar spine surgery fixed with a nail is a question that patients struggle with. So who is in charge of whether or not to fixate for lumbar spine surgery? This is a question that many patients may want to ask, but are too embarrassed to say. In fact, this question is not up to the patient or the surgeon, but depends on the condition and the trade-off between the pros and cons. How to say? 1, any treatment is based on the mechanism and natural history of the disease. Spinal surgery in short includes decompression, lesion removal, fusion and reconstruction for several purposes. Decompression refers to the release of soft or hard structures causing compression of the spinal cord and nerve roots; fusion is used to obtain stability of the spine, often in combination with internal fixation, the former to obtain long-term stability and the latter to obtain near-term stability; reconstruction includes regaining stability and correcting deformity, in many cases using internal fixation and In many cases, internal fixation and spinal fusion are used for reconstructive purposes, such as stability reconstruction after spinal tumor resection and correction of spinal deformities. For common lumbar degenerative diseases such as lumbar disc herniation and lumbar spinal stenosis, nerve decompression is the primary means of obtaining symptomatic relief, so should fusion fixation be used at the same time? There are two conditions that require consideration of internal spinal fixation, where lumbar instability was already present before surgery itself or where decompression may have caused lumbar instability. The former often requires internal fixation to reestablish stability, while the latter has two options, one is the traditional expanded decompression supplemented by fusion fixation of the spine, and the other is a minimally invasive spinal technique with limited decompression to obtain adequate decompression of the nerves while minimizing damage to the stability of the lumbar spine. Therefore, if decompression alone can solve your spinal problem, and if minimally invasive techniques are used to protect the normal tissue structure as much as possible, internal fixation of the spine can often be avoided so that the motion of the spinal segment can be preserved, such as simple lumbar disc herniation and mild to moderate lumbar spinal stenosis; however, if your spine needs to be stabilized or deformity corrected, internal fixation can be avoided. is difficult to avoid, such as lumbar spine fracture, lumbar spine slippage, spinal tumor, spinal deformity, etc. 2. Decide on a treatment plan with the patient. Is there a perfect plan? Any treatment has its pros and cons. The spine itself has the function of support, protection and movement. The nail fixation itself increases the stability of the spine but at the expense of the movement function. Because fixation of the lumbar spine causes a relative increase in motion of adjacent segments, it may lead to accelerated degeneration of adjacent segments and the development of adjacent segmental pathology. In addition, nail fixation itself carries some risk of requiring greater exposure, which can cause damage to the paravertebral muscles, leading to muscle ischemia, necrosis, and denervation. However, after fixation and fusion of the diseased segment, the chance of disc herniation and spinal stenosis in this segment is rare, because the segment motion is eliminated and there is no abnormal force stimulation, so the problem of disc reherniation and spinal stenosis in this segment rarely occurs. The lumbar decompression alone may cause secondary instability of the operated segment, and there is a certain recurrence rate after surgery, such as recurrence of lumbar disc herniation and spinal canal restenosis, but this is not the majority of cases, the key is to choose the right case, the recurrence rate varies from surgeon to surgeon, but overall it is a minority of cases; the benefit is that a less invasive procedure is used, and the motion function of this spinal segment is preserved. For some cases with unsatisfactory clinical outcome, we can still adopt an expanded decompression and internal fixation of the spine fusion, which is a stepwise treatment plan. We need to discuss the pros and cons with the patient, and the role of the physician is to provide specialized advice to help the patient and family make decisions. We need to avoid the tendency to expand the use of internal fixation on the one hand, and on the other hand, patients do not need to worry too much about internal fixation of the spine. The basic principle that should guide our decision making is to obtain the best possible outcome with the least trauma and at the most economical cost. Solving the problem with minimal cost should be a common goal for both the physician and the patient.