Lumbar disc herniation is a common and frequent disease. Most of them are treated clinically by traditional surgery, but some patients have poor surgical outcomes. The diagnosis of lumbar disc herniation mainly relies on detailed history of lumbar pain and clinical signs, with straight leg elevation, local pressure radiating pain and numbness in the lower leg as the most important signs. Some patients need to do imaging examination. Such as CT, myelography and MRI, etc. It is irresponsible to impose surgery on the basis of one imaging result alone for those with atypical clinical signs. During CT reading, lumbar disc bulge, herniation and prolapse should be distinguished and treated correctly. A survey showed that the false positive rate of CT was 8.13%-10.25%, which proved not to be disc herniation but neuritis, deformity and tumor after surgery. 2.Differential diagnosis of low back pain There are many diseases that produce low back pain, which should be differentiated from the following diseases: such as spinal tumor, spondylolisthesis, pear-shaped muscle syndrome, lumbar 5 transverse process hypertrophy syndrome, lumbar 3 transverse process syndrome, rheumatoid, sacroiliac joint strain and lesions of the nerve itself (such as radiculitis, lumbosacral nerve posterior root ganglion ectopic deformity, etc.). Especially in elderly patients, careful history taking and imaging examination are needed to differentiate them. 3, the principle of surgery (1) the choice of surgery: posterior intervertebral disc surgery has three types of surgery: open window method, half laminectomy and total laminectomy. How to choose the operation style should be based on the age and type of protrusion, etc. (2) Key points of surgery: it is important to maintain the stability of the posterior spinal column and minimize the damage to the posterior spinal column structure during surgery. 4. Reasons for poor surgical outcome (1) Positioning errors and missed diagnoses: intraoperative positioning is usually done through spinous process markers and structures unique to the lumbosacral region. (2) Nerve root and cauda equina injury; (3) Bleeding: bleeding mainly originates from the posterior vertebral venous plexus and muscle leakage. A large epidural hematoma can lead to severe early cauda equina compression and distant scar fasciculations. In conclusion, misdiagnosis, mislocalization, nerve injury, and bleeding are the main reasons for poor surgical outcomes in patients with lumbar disc herniation.