Lumbar intervertebral disc herniation is a syndrome manifested by the rupture of the annulus fibrosus and protrusion of the nucleus pulposus on the basis of disc degeneration, which compresses and irritates the nerve root and cauda equina. (I) Etiology 1, lumbar intervertebral disc degeneration; 2, changes in enzyme activity of the intervertebral disc; 3, abnormal matrix proteins and matrix damage; 4, autoimmune reaction. (ii) Clinical manifestations 1, lumbago; 2, sciatica; 3, numbness; 4, claudication; 5, muscle spasm or paralysis; 6, cauda equina syndrome; 7, cone syndrome: inability to empty urine automatically, fecal incontinence or inability to defecate voluntarily, complete loss of penile erection and ejaculation ability. It is difficult to distinguish cone syndrome from cauda equina syndrome, which has more severe sciatica and more extensive sensory and motor deficits in the lower limbs; 8. Decreased skin temperature of the limbs; 9. Edema of the lower legs; 10. Spinal deformities; 11. Muscle weakness and muscle atrophy of the lower limbs; 12. Changes in tendon reflexes; knee tendon reflexes and Achilles tendon reflexes are weakened or absent; 13. Special physical examination: 1) Straight-leg elevation test; positive; 2) Laseque ( Laseque’s sign; 3) healthy limb elevation test; 4) straight leg raising strengthening test (Bragard’s sign); 5) supine belly test; 6) neck flexion test (Lindner’s sign) was positive. 7) Femoral nerve pull test: positive. (C) auxiliary examination 1, X-ray lumbar orthopedic film: can find the narrowing of the intervertebral space, lumbar vertebrae physiological curvature reduction, vertebral margin osteophytes. 2.CT：can clearly show the herniation of intervertebral disc. 3.MRI：clearly show the intervertebral disc degeneration and protrusion. Ultrasound, vertebral canalography, electrophysiology, intervertebral discography, etc. (D) Differential diagnosis 1, acute lumbar sprain. 2.Lumbar muscle strain. 3.Supraspinous and interspinous ligamentitis. Disorders of small joints of lumbar vertebrae. 5. Lumbar spinal stenosis. 6. Slippage of lumbar spine. 7. Tuberculosis of lumbar spine. 8. Third lumbar transverse process syndrome. 9. Tumor in the spinal canal. 10.Pearly muscle outlet syndrome. 11. Pelvic diseases: pelvic inflammation and adnexitis in women. (E) Principles of treatment 1, conservative treatment: bed rest, wearing a lumbar girdle or support, lumbar back muscle exercise, lumbar spine traction, physical therapy (low-frequency, intermediate-frequency, ultrashort-wave electrotherapy, infrared therapy, hydrotherapy, waxing, etc.), massage, acupuncture, dehydration, neurotrophic drugs, the application of nonsteroidal anti-inflammatory and analgesic drugs, epidural or sacral closure, and so on. Epidural or sacral closure treatment. 2.Surgical treatment: Conservative treatment is ineffective, serious lesions require surgical treatment. Surgical methods: nucleus pulposus removal, radiofrequency ablation, nucleus pulposus removal, intervertebral fusion, artificial lumbar disc replacement, intervertebral implant fusion plus internal fixation with pedicle rods and so on. Figure 1 a/b Left paracentral lumbar disc herniation; c After open disc nucleus pulposus removal Figure 2 a Extreme lateral lumbar disc herniation (arrows); b After disc removal expandable interbody fusion implantation