How to choose the treatment method for patients with lumbar disc herniation? 2.Why can’t all patients with lumbar disc herniation be treated with minimally invasive surgery? 3.Patients who need surgery for lumbar disc herniation are always worried about recurrence? How to prevent it? These are the difficult problems that make patients and physicians feel confused, and the final consideration is a problem of efficacy and risk (recurrence), otherwise the second and third surgery will not be successful. I. How to choose the treatment for a patient with a herniated lumbar disc? There are many treatment methods for lumbar disc herniation, but the specific implementation of each patient must be based on the patient’s clinical symptoms, signs and imaging changes in order to develop a more appropriate plan. The current treatment methods are only surgical and non-surgical. 80-90% of patients can obtain more satisfactory results through non-surgical treatment, mainly including: (a) Conservative treatment 1. The symptoms and signs are not obvious. Adolescent patients. Patients with severe medical disease that cannot tolerate surgery. 2. In conservative treatment, an important measure 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 in the disc and eliminate the pain. The pressure in the disc is higher in the sitting position and lowest in the lying position. Therefore, absolute bed rest is necessary, and bed activity will be considered after the symptoms are relieved. In addition, acupuncture and physiotherapy, traction treatment of the pelvis and both lower limbs, and epidural closure treatment with steroids can also be used according to the patient’s condition. Drug therapy mainly plays the role of dehydration, analgesia and nutritional nerve auxiliary treatment. (B) Minimally invasive surgical treatment 1.Injection of drugs to dissolve the nucleus pulposus (lysozyme class, etc.). 2, percutaneous puncture intervertebral disc surgery At present, the main treatment methods are intervertebral disc cut and suck, ozone, plasma, laser, radiofrequency ablation, etc.. It also includes lumbar posterior endoscopic removal of lumbar disc nucleus pulposus tissue (MED). There are a wide variety of localized procedures with varying efficacy. I am more in favor of the MED procedure, which can visually reveal the compression of the spinal cord and nerve roots and achieve definitive results through purposeful decompression. (iii) Surgical treatment The use of ladder therapy for patients with lumbar disc herniation is now the consensus of the academic community. This is at the same time a new concept in treatment. For patients who meet the indications for surgery, more than three months of systematic conservative treatment is ineffective. Those with low back and leg pain who have been treated continuously for more than 1 week without pain relief. Those with typical symptoms, signs and imaging changes. Patients whose condition seriously affects their work and life. If the patient himself or herself requests it.) Choose personalized treatment plan for the patient. 1, the traditional method mainly includes open window, half laminectomy or full laminectomy decompression removal method of the nucleus pulposus. For those with combined lumbar instability or severe spinal stenosis who need to expand the decompression and remove >2/3 of the articular process, it is necessary to consider the use of internal fixation and bone graft fusion. 2, non-fusion surgery artificial lumbar disc replacement and nucleus pulposus replacement, after more than 10 years of clinical efficacy observation, most of the vertebral segments performing lumbar replacement have ossified, so the use of this method in the lumbar spine has a declining trend. At present, the non-fusion technology of the lumbar spine, between the spinous process to be micro-movement device or in the nail, the rod to do micro-movement technology article but also not too popular, the main factor is still attributed to the regional economic underdevelopment, and the efficacy is yet to be observed. Second, why can’t all patients with lumbar disc herniation be treated with minimally invasive surgery Minimally invasive techniques are a developmental direction in the field of spinal surgery, with the advantages of less trauma, less bleeding, faster recovery, and easy acceptance by patients. However, it is constrained by the following factors: the equipment is expensive and not every hospital can acquire it. Difficulty in selecting the surgical procedure. Operators with skilled technique are required. It is a limited surgery. For those 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 selected, otherwise its efficacy will be affected. Third, why do patients with lumbar disc surgery always beware of the problem of recurrence? How to prevent it? Such a worry is not superfluous. Lumbar disc surgery does have a recurrence problem, and some scholars point out that the recurrence rate is as high as about 5-15%. This generally refers to the reappearance of the original (or aggravated) symptoms and signs 1 year after surgery. The recurrence is considered when the imaging is in the same segment again. The factors of recurrence are complex and include: unclean removal of the medulla. The traditional method is to remove 1/3 or 1/4 of the nucleus pulposus (about 3-5 grams). This needs to be done with the operator’s extensive operative experience and experience. Patients with preoperative lumbar instability (dynamic radiographs) combined with disc herniation. In cases where only the nucleus pulposus is removed, the herniation of the nucleus pulposus can occur again with the movement of the unstable vertebral segment. Patients who have had lumbar disc herniation surgery are prone to degeneration of the adjacent vertebral segments and can develop herniated discs in adjacent segments. Patients are often linked to the first surgery, and for a definitive diagnosis another MRI of the lumbar spine must be performed to confirm the diagnosis! Methods of prevention: Patients must seek consultation with a specialist. A senior specialist can provide a profound and comprehensive analysis of the condition and personalize the treatment plan, and the recurrence rate is significantly lower in spine specialist operations than in non-specialist operations. For patients with lumbar instability, removal of the herniated nucleus pulposus along with posterior internal fixation and bone grafting fusion is used to achieve a satisfactory outcome.