Minimally invasive treatment of the intervertebral disc is a minimally invasive technique that involves the placement of instruments or drugs into the diseased tissue with minimal trauma (no skin incision, only a puncture needle) and physical, mechanical or chemical treatment, called minimally invasive interventional therapy. Minimally invasive interventional disc system has common advantages: no incision, small trauma, few complications, high safety and easy operation, etc. It also has roughly the same treatment indications: anyone who fails to achieve results after 3-6 months of conservative treatment, excluding giant herniation/free herniation or severe spinal stenosis and cauda equina damage. However, due to the different mechanisms of action of its various minimally invasive techniques of treatment, some producing physical effects and some producing chemical effects, it produces different ablative effects on various types of disc herniation. They are complementary to each other and not substitutes for each other. If a patient with disc herniation has multiple segments with different types of herniation, the combined application of minimally invasive interventional techniques can selectively enhance the ablative effect and be more effective. What are the specific methods of minimally invasive interventional treatment for cervical and lumbar spondylosis? In recent years, scholars at home and abroad have done a lot of exploration on the minimally invasive treatment of disc herniation, and minimally invasive interventional treatment of disc herniation has been accepted by more and more people. At present, Heilongjiang Red Cross Hospital mainly introduces international advanced minimally invasive interventional techniques: laser disc vaporization and decompression, ozone nucleus pulposus ablation, low-temperature plasma radiofrequency ablation, minimally invasive discoscopy, and so on. Some of these technologies can be combined in the clinical application to achieve better treatment effect. 1, percutaneous puncture techniques 1.1 Percutaneous myelolysis In 1964, Smith first reported percutaneous disc myelolysis, which pioneered minimally invasive spinal surgery techniques. The basic principle of this technique is that papaya rennet can depolymerize proteoglycans in the nucleus pulposus, causing the nucleus pulposus to dissolve and dehydrate, thus achieving indirect decompression of the intervertebral disc and relieving nerve root compression. After a series of experimental and clinical studies, it was confirmed that papaya protease nucleolysis technique has more definite efficacy and was approved for clinical application in 1982, with a clinical excellence rate of 70% to 80%. The main indications for this procedure include: (1) sciatica as the main symptom; (2) positive straight leg raising test; (3) no calcification of the herniated intervertebral disc, and the total efficiency of its treatment reaches 85.2%. The main complications of myelolysis are allergic reaction (0.5%), brain and spinal cord injury (0.03%), burning neuralgia, and discitis, etc. Complications are rare but often have serious consequences [3]. Currently, collagenase is used more often, which can dissolve collagen in the nucleus pulposus and fibrous ring without damaging the enzymes in the adjacent structures, and has a lower allergic reaction, and has replaced papaya rennet clinically; other drugs under development include metalloproteinase and chondroitinase. 1.2 Percutaneous discectomy Minimally invasive treatment of lumbar disc herniation has developed rapidly after the development of percutaneous lumbar discectomy, the basic principle of which is to mechanically cut and remove the nucleus pulposus through a working cannula placed in the diseased disc by percutaneous puncture technique and through special instruments. Onik et al [4] reported excellent rates of 72% to 86%. The main disadvantage is that the procedure is performed under fluoroscopy rather than direct vision, and the herniated disc tissue cannot be removed during surgery, making it difficult to obtain complete decompression [56].The technique was performed in China in the early 1990s, and common complications were intervertebral infection and postoperative recurrence [67]. However, the emergence of this technique has made two contributions: firstly, the development of suitable special small instruments, which laid the foundation for the development of modern minimally invasive spinal surgical instruments; secondly, the description of the concept of “safe working area”, i.e., the area between the nerve root, the superior articular process, and the upper edge of the vertebral body, and currently, the postero-lateral type The postero-lateral intervertebral discoscopy is also performed in this area. 1.3 Percutaneous laser disc vaporization decompression Most scholars currently believe that the main mechanism of PLDD is that after laser vaporization and partial ablation of the nucleus pulposus, the intradiscal pressure decreases significantly, even causing the herniated disc tissue to retract, thus reducing nerve root compression and relieving clinical symptoms. The main complications include infection, neurovascular injury due to laser thermal effect, and secondary spinal stenosis. Through clinical practice, the author believes that PLDD has certain advantages compared with other minimally invasive treatments for disc disorders such as chemical nucleolysis, percutaneous discectomy and endoscopic discectomy, such as no chemical side effects; less tissue damage; and satisfactory clinical results. In recent years, this surgical method has been well developed in China and has gained the praise and trust of the majority of patients. 2, endoscopic-assisted technology 2.1 Intradiscal electrothermal therapy (IDET) The basic principle of IDET is to use a radio-probe type heat-resistant SpinCath catheter to raise the temperature inside the fibrous ring enough to denature and coagulate the nerve fibers. When the tissue is heated to a certain temperature it also causes the covalent bonds that maintain the triple helix structure of the collagen fibers to break, the collagen molecules to contract and thicken, the fissures in the annulus fibrosus to rejoin and reinforce, thus allowing the tears to heal and the biomechanical state of the annulus fibrosus to improve.The initial reports of clinical efficacy of IDET are encouraging, as it provides a minimally invasive treatment for refractory discogenic lower back pain that has significant advantages over intervertebral fusion It has significant advantages over interbody fusion. However, with further research, Davis et al [9] recently followed 44 cases after 1 year of IDET treatment and found that 92% still had persistent low back pain, 29% had worse pain than before treatment, and more than half of the cases were not satisfied with the clinical outcome. more satisfactory results were achieved in those cases where the catheter was placed correctly. 2.2 Radiofrequency ablation myeloplasty Radiofrequency ablation myeloplasty is used for the treatment of lumbar disc herniation and discogenic lower back pain. The mechanism of action is to remove part of the nucleus pulposus using cold fusion cut vaporization technique (about 40°C) and to vaporize, contract and solidify the collagen fibers in the nucleus pulposus using heating (70°C) technique, which reduces the total volume of the disc, thereby reducing the intradiscal pressure and causing remodeling of the disc nucleus pulposus tissue for therapeutic purposes. Long Hengguo et al [3] reported that the recent efficiency of radiofrequency ablation myeloplasty for lumbar disc herniation was more than 80%, and the immediate postoperative effect was satisfactory, but the regression of the efficacy was more significant in the mid-term follow-up; Wang Xiaoning et al [11] analyzed that the reason may be that the load on the lumbar spine is large, and limited ablation is not easy to maintain the efficacy. Compared with laser vaporization decompression, the decompression effect of radiofrequency ablation myeloplasty is relatively limited, and animal experiments have confirmed that the nucleus pulposus after ablation cannot be observed as a retraction of the posterior edge of the disc visible to the naked eye. 2.3 Laparoscopic lumbar discectomy Laparoscopic lumbar discectomy was carried out in 1991. Due to the small incision of laparoscopy, there is less interference with the abdominal organs, short intestinal paralysis time, and the degree of postoperative wound pain is significantly reduced, thus greatly shortening the hospital stay and significantly reducing intraoperative bleeding compared with open surgery. However, the main purpose of lumbar disc herniation surgery is nerve root decompression, and laparoscopic anterior surgery does not enter the spinal canal, which actually cannot perform the above decompression, so this procedure is often incomplete and has higher complications such as retrograde ejaculation, ureteral injury and intestinal injury, which are also rarely reported clinically. 2.4 Microendoscopic lumbar discectomy The discoscopic technique draws on the advantages of the traditional posterior laminar gap opening technique and the minimally invasive endoscopic technique, and through a series of dilating cannulae, a minimally invasive working channel of 1.6 cm to 1.8 cm in diameter is finally formed, and the channel containing the illumination and image transmission system is entered to the site of the herniated disc, and then, under the surveillance of the TV screen, special surgical instruments are used to The herniated disc is then removed using special surgical instruments under the supervision of a television screen. The advantage of this technique over the percutaneous technique is that it allows direct visualization and a 64-fold magnification of the surgical field, which allows for more accurate identification and protection of the dural sac, nerve roots, and intravertebral plexus in the surgical field area and maximizes the integrity of the posterior spinal ligament complex, thereby effectively reducing the incidence of postoperative scar adhesions and lumbar instability. The techniques carried out above can be used in combination to treat patients with special and complex lumbar disc herniation, which can achieve good and stable results.