Lumbar spinal stenosis and lumbar disc herniation are both degenerative diseases of the lumbar spine and are often confused, but there are many differences between the two diseases. For example, lumbar spinal stenosis is more likely to occur in people over 50 years of age, while lumbar disc herniation is more likely to occur in young people between 20 and 40 years of age. Patients with lumbar spinal stenosis may not experience any discomfort at rest, but if they walk or stand for a long time, they may experience radioactive pain, numbness, or weakness in the lower extremities. Patients with lumbar spinal stenosis can often ride a bicycle and push a car inside a supermarket for a long time. The radiating pain in the lower extremities of lumbar disc herniation tends to be persistent and difficult to be relieved by squatting or lying down. The clinical manifestations of the two diseases are different because their pathogenesis is different. Lumbar spinal stenosis is caused by a herniated disc, osteophytes of the synovial joint, hypertrophy of the ligamentum flavum, degenerative slippage and other factors resulting in a decrease in the diameter of the central spinal canal, lateral spinal canal or neural foramen of the lumbar spine. When walking or standing for a long time, the pressure in the spinal canal increases resulting in poor venous return and nerve root ischemia resulting in pain. At this time, if the lumbar spine is flexed, the spinal stenosis is reduced because the intervertebral discs and ligamentum flavum are “flattened” to some extent, thus reducing the symptoms. This is why patients are less likely to experience pain when riding a bicycle or pushing a cart. The pain of lumbar disc herniation is due to a number of inflammatory reactions caused by disc herniation, rupture of the annulus fibrosus, and exposure of the nucleus pulposus tissue. Neurogenic intermittent claudication in lumbar spinal stenosis needs to be differentiated from vascular intermittent claudication in arterial obstructive disease of the lower extremities. The latter may be characterized by decreased arterial pulsation and decreased skin temperature in the lower extremities and does not present with the pain on standing and relief of lumbar flexion that is characteristic of patients with lumbar spinal stenosis. The degree of lumbar spinal stenosis needs to be assessed by CT and MRI. Patients generally read the CT and MRI imaging reports carefully, but it is recommended to ask an orthopedic surgeon to interpret the condition reflected by the films. This is because, in most people over the age of 40 who have these tests, the reports will show things like “bulging disc”, “herniated disc”, “spinal stenosis”, and “dural sac compression”, The words “dural sac compression” and even “nerve root compression” will undoubtedly cause a lot of psychological stress to the patient. In fact, many imaging stenoses do not necessarily compress nerves or produce clinical symptoms. In other words, only spinal stenosis that corresponds to the patient’s clinical presentation makes sense for a diagnosis of lumbar spinal stenosis. Lumbar spinal stenosis is different from lumbar disc herniation. The latter is an inflammatory reaction due to a herniated nucleus pulposus, and the symptoms will be relieved when the inflammation subsides with anti-inflammatory treatment and time. Lumbar spinal stenosis, on the other hand, is a series of symptoms due to increased pressure in the spinal canal caused by spinal stenosis, and therefore responds to anti-inflammatory drugs and analgesics in general. You can do lumbar back exercises, because patients with lumbar spinal stenosis are more or less accompanied by some instability factors that cause symptoms, so strengthening the lumbar back muscles can delay the progress of the disease to some extent by increasing the stability of the lumbar spine. A lumbar spine support can also be worn for a short period of time, not recommended to exceed 2 weeks. The natural course of lumbar spinal stenosis is that approximately one-third to one-half of patients will improve clinically and approximately 15% will have significant deterioration. The rest of the patients may be in a state of repeated fluctuations and slow progression. If the symptoms are not very severe, such as being able to walk more than 2-3 km without difficulty although there is some pain in the lower extremities, and the offense is not very long or relatively infrequent (1-2 times a year, or only after exertion), the patient falls into the first category and can continue to be observed. If you can walk only 300-500 meters or less and need to rest, or if you have numbness and weakness in the lower extremities, and if conservative treatment for many years is ineffective or progressive, or if you even have numbness in the perineal area and have difficulty controlling urination or defecation, you should consider surgery. In fact, the above two cases are easy to decide, but the third case is difficult to choose, that is, the symptoms are sometimes good and sometimes bad, and when they are good, they are not normal, and when they are bad, they are not unable to go down. Through long follow-up, we did observe a phenomenon, that is, this part of the “bad” patients with surgery and non-surgical patients 20 years later, their situation may be similar. In other words, the surgical patients may improve very well for a while after surgery, but gradually problems will appear again, while the non-surgical patients’ condition may decline slowly and may improve somewhat at a later stage (this improvement is the result of severe degeneration of the lumbar spine instead of spontaneous stabilization). So how do we choose? This is the time to let the patient think and choose from the perspective of his or her actual situation and his or her quality of life requirements. If you are 50-60 years old and still in good health except for this problem, or if your job requires it, or if you have more hobbies and need to have a higher quality of life, and the problems of the lumbar spine greatly affect the above requirements, it is recommended to consider surgery. After all, this surgery can greatly improve the quality of life. Although the efficacy of the surgery may be discounted after a number of years after the operation, at least it can gain a lot of time. If one is already close to 70 years old and has some minor physical problems, such as hypertension and diabetes, it is recommended to observe closely for 1-2 years, and if the lumbar spine problem is progressing and the spinal stenosis is indeed very significant, surgery is recommended because this disease will progress, and if it is delayed until after 75 years old, then the symptoms may be even worse at that time.