Core Tip: It is often said that the spine is the source of many diseases. Indeed, some people do housework all day and feel more tired than at work. Experts warn that long-term bending, sedentary, standing are very susceptible to lumbar disc herniation, such as computer workers, drivers, accountants, office workers, etc.. The lumbar intervertebral disc starts to degenerate and age after the age of 20, and in some improper positions such as sitting, bending over to carry heavy objects or incorrect twisting, it will cause the lumbar intervertebral disc to protrude to the back side, causing acute pain and inflammation of the spinal nerve roots when compressing them, leading to pain or discomfort in the corresponding parts of the torso, with a high prevalence in young and middle-aged people. Conservative treatment requires absolute bed rest [Clinical case] Mr. Chen, 29 years old, is usually physically fit and likes sports. One day he was playing with his son and threw him up to catch him with his hands, when he suddenly felt severe pain in his lower back, making it difficult to even walk. Later, he was admitted to the hospital after X-ray and CT examination and found that Mr. Chen’s lumbar disc ruptured and the nucleus pulposus protruded and compressed the nerve. Experts recommended conservative treatment, and Mr. Chen lay in bed for a whole month. [Experts explain] conservative treatment, that is, non-surgical treatment, the selection of indications mainly includes: the course of the disease within 3 months, the first onset, symptoms and signs are not obvious; adolescent patients; combined with serious medical disease and can not tolerate surgery. In conservative treatment, the most important thing is that the patient must be absolutely bedridden, and pain is the first symptom in patients with lumbar disc herniation, regardless of the cause. The aim of treatment is to reduce the pressure within the disc and eliminate the pain. The pressure within the disc is greater in the sitting position and least in the lying position, so absolute bed rest is necessary and bed activity will be considered after the symptoms are relieved. In addition, acupuncture and physiotherapy, traction therapy for the pelvis and both lower extremities, and epidural injection therapy with steroids are available at the patient’s discretion. Drug therapy mainly plays the role of dehydration, analgesia and nerve nutrition and adjuvant therapy. Bed rest treatment should pay attention to the requirement of lying on a hard bed; when lying on the back, the lumbar area should be padded with a thin pillow to allow the trunk muscles to relax; and bed rest should be strictly adhered to. Even if the symptoms allow to get out of bed, can not do lumbar flexion and extension movements; bed rest in the need to insist on bed urination and defecation, such as can not adapt, can be assisted to the floor urination and defecation. Physiotherapy should also be noted, acute sprain-induced lumbar disc herniation, the injury should rest 1 to 2 days before physiotherapy. Physiotherapy is not suitable for patients with septic disease, eczema or dermatitis in the lumbar region, or with active tuberculosis. Patients with cardiac pacemakers are prohibited from cross-frequency electrotherapy and magnetic therapy. If symptoms worsen during physical therapy, treatment may be suspended. Clinical case] Auntie Wang, 55 years old, 3 years after lower lumbar spine surgery, recurrence of lumbar pain, aggravation for 1 year, current history of recurrent lumbar pain for 4 years, aggravation and left lumbar pain for 3 days, then under general anesthesia for lumbar spine slippage, decompression implantation internal fixation, healed and discharged. Why are middle-aged and elderly people prone to lumbar and leg disease? It is a symptom of degenerative disease. As age increases, the spine is prone to aging (degeneration), hypertrophic spondylitis, cervical and lumbar instability, and age-related hunchback deformity, all of which can lead to cervical and lumbar spine pain. There is an academic consensus on the use of step therapy for patients with lumbar disc herniation. For patients who meet the indications for surgery, such as those who have been ineffective in systematic conservative treatment for more than 3 months; those who have been continuously treated for more than 1 week for lumbar and leg pain without pain relief; those with typical symptoms, signs and imaging changes; those whose condition seriously affects work and life; and those who are requested by the patients themselves, personalized treatment plans can be selected according to the patients’ conditions. The traditional methods mainly include open, half-plate or full-plate laminectomy to decompress and remove the nucleus pulposus. For those with combined lumbar instability or severe spinal stenosis, expanded decompression is required. In cases where more than 2/3 of the articular process is removed, treatment with internal fixation and bone graft fusion is considered. In addition, there are artificial lumbar disc replacement and nucleus pulposus replacement, after more than 10 years of clinical efficacy observation, most of the vertebral segments performing lumbar disc replacement have ossification phenomenon, so the use of this method in the lumbar spine has a decreasing trend. “Clinical case] Ms. Shi, 48 years old, was admitted to the hospital because of low back pain combined with right lower limb pain for 2 years, and then her condition worsened. She was diagnosed with lumbar disc herniation and had been treated at several hospitals, all of which recommended traditional open surgery, which the patient was unwilling to accept. The expert explained] Minimally invasive surgical treatment mainly includes injection of drugs to dissolve the nucleus pulposus (lysozyme type, etc.) and percutaneous puncture disc surgery. Percutaneous puncture disc surgery is currently used more often, and currently there are mainly disc excision and suction, ozone, plasma, laser, radiofrequency ablation and other treatment methods, as well as lumbar posterior endoscopic removal of lumbar disc nucleus pulposus (MED) surgery. The emergence of “intervertebral foraminoscopy” at the beginning of the 21st century has brought the minimally invasive treatment of disc herniation to a whole new level, which is superior to ozone and collagenase lysis, and is the most minimally invasive, safe and economical technology. It is the most minimally invasive, safe and economical technique available. Currently, it has become the leading surgical procedure for spinal disorders in foreign countries; in China, it is commonly performed and rapidly developing in Beijing, Shanghai and Guangzhou. The advantages of minimally invasive techniques are less trauma, less bleeding, faster recovery, and easier acceptance by patients. However, it is constrained by the following factors: the equipment is expensive and not every hospital can purchase it; it is difficult to choose the procedure; it requires skilled operators; and it is a limited procedure. For patients with long duration of disease, severe nerve root scar adhesions, and severe stenosis of the spinal canal caused by combined lumbar (true) slippage or vertebral body posterior margin dissection, minimally invasive surgery should not be chosen, otherwise its efficacy will be affected. How can post-operative patients prevent recurrence? The first step is to see a specialist and choose a personalized treatment plan. For patients with lumbar instability, removal of the herniated nucleus pulposus should be accompanied by posterior internal fixation and bone graft fusion to achieve satisfactory results.