The latest minimally invasive method for the treatment of pain caused by herniated discs Patients with low back and leg pain are relatively common patients in clinical practice, and most of these patients’ symptoms are caused by herniated discs, the pathogenesis of which mainly lies in degenerative changes in the lumbar discs, trauma and strain, resulting in the weakening or even rupture of the fibrous annulus, which is the main scaffold of the discs. The lumbar intervertebral disc protrudes into the posterior spinal canal or ruptures and prolapses, resulting in stimulation or compression of adjacent tissues such as spinal nerve roots and spinal cord, resulting in clinical symptoms such as lumbar pain, unilateral or bilateral lower extremity numbness and pain. Different patients have different disease duration, different protrusions, different conditions, and different treatment methods. Current treatment methods can be divided into surgical and non-surgical therapies. Surgical therapy includes incisional disc removal, percutaneous disc removal or aspiration, etc. Non-surgical therapy includes conservative therapy and interventional therapy. Traction, physiotherapy, massage, acupuncture and closed therapy are all conservative therapies. Interventional therapy is a minimally invasive technique that uses a puncture method to reach the lumbar intervertebral disc and treat the lesion under the guidance of CT or C-arm X-ray machine. There are collagenase lysis, laser decompression, radiofrequency nucleoplasty, ozone injection and targeted radiofrequency thermocoagulation, and radiofrequency repair of the fibrous ring. Among many treatment methods, radiofrequency targeted thermal coagulation is the safest, most efficient, least painful, least complicated, easiest to operate, least expensive and most widely used new treatment method for cervical and lumbar disc herniation that can treat the herniated area without damaging the normal disc tissue, and is a qualitative leap in the minimally invasive treatment of disc herniation breaking the traditional disc treatment. Radiofrequency Targeted Thermocoagulation Surgical Method Radiofrequency thermocoagulation target treatment technology is to accurately place the radiofrequency needle to the onset site with the help of the electrical stimulation function of the radiofrequency temperature-controlled thermocoagulator and the impedance monitoring system, and precisely control the extent of the injury foci by adjusting the size of the radiofrequency output power and setting the action temperature, i.e., just use a special puncture needle of 0.7mm in diameter to accurately puncture the center of the disc under the surveillance of digital subtraction or CT. After confirming the safety, direct thermal coagulation and temperature control treatment is performed to promote the molecular movement of the protruding intervertebral disc tissue to generate heat, resulting in the degeneration, coagulation, shrinkage and volume reduction of the protruding intervertebral disc tissue, thus relieving the compression of the nerve without injuring the normal intervertebral disc tissue and surrounding nerves. After thermal coagulation, the volume of the herniated disc tissue shrinks and the nerve root is separated from the nerve root, while the thermal effect on the injured annulus fibrosus, edematous nerve root and inflammatory reaction in the spinal canal will achieve a good therapeutic effect, and the whole treatment process will not cause any obvious discomfort to the patient in just about ten minutes, and the patient’s symptoms will soon be reduced or disappear. This treatment is not open, no pain, no side effects, hospitalization for three days, not easy to relapse. The six safety measures of radiofrequency thermal coagulation target treatment of disc herniation The six safety guarantees of radiofrequency target thermal coagulation have completely solved the medical safety and healing effect problems that patients and doctors are most concerned about now. 1, radiofrequency thermal coagulation target treatment is in the C-arm X-ray machine under the accurate positioning of time detection, under the precise guidance of direct action on the lesion of the nucleus pulposus, data accurate to less than 1mm, the angle error is less than 1 degree, so that the treatment is more accurate, more effective, almost without injury to any normal tissue. 2, the neurological system special radio frequency has a unique precise identification and stimulation function of the nervous system, can measure the nerves within 1cm of the treatment range, and accurate to distinguish motor nerves or sensory nerves, that is, in the treatment of disease you want to damage the patient’s nerves are not possible. 3, the radio frequency instrument has a unique impedance display function, can accurately distinguish the treatment site is what tissue, its impedance is how much. Simply put, this equipment can distinguish the nucleus pulposus fiber ring, calcification point, bone and blood vessels, and accurately display with tone and digital, so that the treatment is more accurate and safe. 4, the controllability of the temperature: radio frequency instrument can adjust the temperature arbitrarily, the error is below 2 degrees Celsius to ensure the safety of the treatment, no infection and no heat damage after treatment. 5.Nervous system special radio frequency unique treatment range of precise calculation function. It can accurately calculate the volume of the nucleus pulposus to be removed before treatment and make a plan, that is to say, how much of the nucleus pulposus of the lesion will be removed without injuring any normal tissue, making the treatment more humane and effective, compared with other treatment methods there is a qualitative change, whether it is laser, spinal canaloscopy, fiber ring repair, ozone or collagenase injection, percutaneous excision and suction, it is to remove the good nucleus pulposus and let the lesion part to retract. And this method is which place has the disease to remove which place, no disease place is not hurt in the slightest. 6, the treatment electrode of the special RF instrument for the nervous system is only 0.71mm, just like an acupuncture needle, the whole treatment without anesthesia, analgesics, antibiotics, hormones, just a physical change process, without any side effects on the human body, making the treatment greener and more humane. These six security measures are not available in any minimally invasive equipment and methods, it brings the safety and efficacy issues that doctors and patients are most concerned about to the extreme, making it easy and natural for doctors to do spinal surgery to cure herniated discs, while changing the history of treating intervertebral discs, changing the treatment method with the main purpose of speeding up degeneration to a treatment method with the main purpose of repair. The treatment of herniated disc, cervical spondylosis and spinal cord type cervical spondylosis has been pushed to the pinnacle of the medical world. Advantages of radiofrequency targeted thermal coagulation technology applied to the treatment of cervical spondylosis Because of the complex structure of the anterior cervical region, there are many important tissues, such as the common carotid artery, jugular vein, thyroid gland, trachea, recurrent laryngeal nerve, esophagus, etc., there is a possibility of damaging these tissue structures during puncture and serious complications. Excessive puncture can cause damage to the spinal cord, making it a high-risk area for treatment due to its special location, and cases of paraplegia have occurred during surgical procedures. The key to successful treatment of cervical spondylosis is the accuracy of the puncture and the safety of the treatment process. Treatment devices such as excisional suction and discoscopy have thicker working cannula diameters and excessive puncture risks, and are therefore not suitable for the treatment of cervical spondylosis. The following analysis focuses on the application of ozonolysis, PLDD, NP, and radiofrequency targeted thermocoagulation in the treatment of cervical disc herniation. Compared with the four, the RF instrument has the thinnest puncture needle diameter (0.71 mm) and therefore its puncture risk is relatively the lowest. Since ozone is extremely destructive to pulmonary epithelial cells, if it is accidentally punctured into the trachea, resulting in ozone inhalation, serious consequences may occur during the procedure that are difficult to control, which requires extremely strong puncture skills of the physician practicing ozone therapy and also raises the risk of the procedure to a great extent. The thermal damage range of PLDD is large, and NP cannot precisely distinguish the important nerves and blood vessels and other tissues in the adjacent areas, plus the patient is prone to choking or swallowing action during the treatment, which may accidentally damage these important organs if a little care is not taken. The destruction range of the radiofrequency instrument can be precisely measured and controlled, and its unique neurophysiological testing system can ensure the safety of the treatment target. Therefore, these shortcomings of ozone, PLDD, NP and other treatment methods can be compensated by radiofrequency therapy, and radiofrequency targeted thermal coagulation therapy should be preferred in the treatment of cervical spondylosis. Comparison of various minimally invasive treatment methods for intervertebral discs Over the decades, people have tried many aspects of the treatment of lumbar spondylosis, and have also created and developed a variety of treatment methods. They can be divided into non-invasive conservative treatment, surgical open surgery and minimally invasive treatment. Conservative treatment can cure 90% of patients, and is more effective for those who have a first attack or a short attack, a small disc herniation, a relatively mild compression of the spinal cord or nerve roots, and mild symptoms. Usually, drugs are taken internally and applied externally, massage and manipulation, mechanical and electric traction, local closure, sacral anesthesia and so on. For different conditions, as long as they are properly applied, they all have certain effects. But these conservative treatment methods are mainly for the lumbar intervertebral disc compression nerve root caused by the nerve radiculitis symptomatic treatment effect, often can only eliminate or reduce the symptoms, but can not cure the lumbar intervertebral disc herniation, so there is a slow recovery, easy to recur deficiencies. For cases where the disc herniation is large and has significant compression on the spinal cord and nerves, there are treatments that can even aggravate the condition when used improperly, and should be used with care and caution. The traditional surgical opening is a complete solution to the problem. The surgical treatment of lumbar disc herniation used to be mostly open surgery to remove the nucleus pulposus of the disc, and the success rate of the surgery was also relatively high, but it was due to large surgical incisions, extensive tissue stripping, bleeding, unavoidable soft tissue damage, bone damage, disruption of spinal stability, bed rest and long postoperative recovery time, as well as the more common nerve adhesions or adhesions in the epidural cavity are more common, and patients are afraid of surgical treatment. Patients are often not easily accepted, and some patients survive in pain because of the fear of surgery. Therefore, many medical workers and patients with low back pain desire an ideal method that is non-invasive, less invasive, less painful, faster recovery, more effective, safe and simple. One of the important trends in modern surgery is the limited and minimally invasive nature of surgery, and with the rapid development of medical technology, the study of minimally invasive spine surgery has become a hot spot in spine surgery today. Since the 1990s, the introduction of various international minimally invasive treatment techniques in China has brought disc treatment to a new level, and its minimal trauma and safety have gradually attracted widespread attention. Some minimally invasive surgeries have been widely used in clinical practice, such as nucleolysis, excision and suction, discoscopy, etc. At present, the methods of using minimally invasive surgery to treat disc herniation at home and abroad are: 1. Collagenase nucleolysis: a collagenase that has a specific dissolving effect on the nucleus pulposus of the disc is injected into the disc or epidural cavity to dissolve and absorb the nucleus pulposus for the purpose of intra-disc decompression and treatment. It started in the 1960s abroad. At present, the application in clinical practice has been decreasing. 2, percutaneous lumbar discectomy and aspiration (PLD): under image monitoring, the working trocar is directly inserted into the intervertebral disc, and some of the nucleus pulposus is removed by using the clamp cutting and negative pressure system, thus reducing the pressure in the disc and the pressure in the annulus fibrosus, and relieving the compression on the nerve root. 3. Percutaneous endoscopic discectomy (PED): discoscopy is divided into lateral discoscopy and posterior discoscopy. Lateral discoscopy is an additional discoscopy system on top of excision and aspiration, making it safer and more effective to perform excision and aspiration under discoscopic monitoring. The posterior approach is a fusion of the advantages of the lateral approach discoscopy and the small interlaminar window technology, only a small opening in the corresponding point of the disc lesion, into the discoscopy system, using fine surgical instruments, to complete the process of removing the lesion nucleus pulposus, to achieve the purpose of treatment. 4, percutaneous laser lumbar disc decompression (PLDD): the use of laser energy to cavitate the diseased nucleus pulposus, reduce the pressure in the disc, relieve and eliminate the compression of the sciatic nerve or spinal nerve and achieve the purpose of treatment. 5.Ozone nucleolysis (PIMOI): This therapy uses a fine needle to puncture into the intervertebral disc and inject a small amount of ozone gas to dehydrate and shrink the nucleus pulposus to achieve the purpose of decompression of the intervertebral disc. The main principle is to use the instantaneous completion of the ozone, powerful oxidation function, to achieve dehydration, anti-inflammatory and analgesic effects. 6. Intradiscal electrothermal therapy (IDET): used to treat lower back pain associated with rupture of the annulus fibrosus. Under the monitoring of imaging equipment, an annular metal thermal electrode is inserted into the annulus fibrosus through a guide needle to repair the damaged annulus fibrosus through heating while destroying the hypersensitive nerve endings within the annulus fibrosus. This is a heating denervation method for the treatment of lower back pain. 7.Radiofrequency ablation nucleoplasty (NP): a radiofrequency vaporizing rod is punctured into the nucleus pulposus, and the energy generated by bipolar radiofrequency is used to convert the electrolyte between the radiofrequency tip and the tissue into an ionic vapor layer of plasma. Multiple grooves are cut into the disc, thereby relieving pain and reducing the irritation of the nerve roots by the disc tissue. These minimally invasive treatment methods either indirectly achieve decompression by reducing the volume of the nucleus pulposus or by repairing the annulus fibrosus, but they do not directly target the herniated nucleus pulposus and are associated with many complications such as bleeding, infection, narrowing of the intervertebral space, and a higher incidence of nerve injury. For this reason, we designed a minimally invasive treatment method, radiofrequency targeted thermal coagulation therapy, which can not only directly eliminate the nucleus pulposus tissue compressing the nerve, but also repair the fibrous ring and eliminate the inflammatory factor stimulating the hypersensitive nerve endings in the fibrous ring, by using the functional characteristics of radiofrequency instrument, after operating under direct vision and repeated clinical practice. We have done an analysis of the advantages and disadvantages of various minimally invasive treatments: a. Analysis of the advantages and disadvantages of collagenase nucleolysis Collagenase nucleolysis is a minimally invasive interventional therapy that uses collagenase injection to selectively dissolve the collagen fibers in the nucleus pulposus, which is one of the effective means to eliminate open surgery for lumbar disc herniation that is unanimously recognized at home and abroad. Its characteristics of small trauma, simple operation and few complications once made it the preferred minimally invasive treatment for disc herniation, but as the treatment research continues, its shortcomings become more and more obvious. Here are four points worthy of attention: 1. The puncture must be accurate, i.e., it must be punctured into the disc or around the herniated disc (the puncture needle is close to the herniation), which raises the requirements for the puncture technique; 2. The concentration of collagenase must be locally saturated in the herniated disc in order to effectively dissolve the herniation. If collagenase is only injected into the anterior/posterior epidural space, it is difficult to ensure that the collagenase gathers or reaches sufficient concentration locally or around the herniated disc, and the effect of these factors on the dissolution of the herniated disc can be imagined; 3. As a protein, collagenase can only be active at a suitable pH and temperature, and if these two basic conditions are lost, the enzyme activity will be largely or completely lost. 4, In addition, we need to emphasize that, because the collagenase aqueous solution at room temperature is extremely unstable, must be stored at low temperature, so collagenase are lyophilized preparations. If it is left at room temperature for 2 hours, its activity will be reduced by 40%. If it is left for 6 hours, the activity will be reduced by 75%. Therefore, it cannot be prepared in advance, which will prolong the procedure to some extent. In the choice of treatment precision, because collagenase is highly mobile, it is impossible to control or predict the extent of its diffusion when injected into the disc, thus causing inevitable damage to the normal nucleus pulposus tissue as well. If the dose or concentration is not mastered accurately enough, a large amount of normal nucleus pulposus tissue may be lost, thus seriously affecting the stability of the spine. In addition, collagenase nucleolysis has its own side effects and complications that cannot be ignored: Side effects of collagenase nucleolysis: 1. Pain reaction. Generally, the pain can be aggravated 3-10 days after treatment than before treatment. The reason is that the injection of collagenase increases the volume of the disc and the degradation of collagen fibers under the action of collagenase, which leads to the increase of the disc contents and the increase of the intradiscal pressure and the chemical stimulation reaction during the degradation process, which occurs after the sinus spinal nerve is provoked. 2. Urinary retention and intestinal paralysis. It is caused by the agitation of the sinus nerve after the increase of intra-disc pressure that causes plant nerve dysfunction. 3.Spinal instability low back pain. After the disc lysis, the vertebral space becomes narrower and the small joints will overlap, and reflex low back discomfort and pain occurs due to the stimulation of sinus reflex nerve. Complications of collagenase nucleolysis 1. Allergic reaction: collagenase as a biological agent, there is a possibility of allergic reaction. 2, intervertebral space infection: manifested as lumbar muscle spasm, increased low back pain with deep pressure pain, white blood cell count and classification may be normal or elevated, and increased blood sedimentation. 3, nerve injury: most of the puncture needles pierce the spinal nerve roots or the puncture process accidentally injures the spinal membrane or the outer nerve membrane, high concentration of collagenase causes dehydration and denaturation of the nerve roots, and once it is mistakenly introduced into the subarachnoid space, chemical meningitis occurs in the mild cases, and paraplegia may occur in the severe cases. The incidence of collagenase complications is very low, but if they do occur, they can all lead to irreversible consequences. Therefore, we can see that collagenase has more safety hazards in the puncture process, chemical properties, preservation methods, and treatment results, which has a non-negligible restriction on its application. Second, the analysis of the advantages and disadvantages of percutaneous excision and aspiration After Hijidata’s first percutaneous puncture disc removal in 1975, over the past thirty years, with the development of interventional radiology, the research on percutaneous excision and aspiration for herniated disc has also made new achievements. Whether it is the disc arthroscopy introduced from abroad or the nucleus pulposus cutter developed in China, it has good effect on the treatment of simple disc herniation. Research has proved that cutting and sucking out part of the disc nucleus pulposus has the effect of decompression, evacuation and return. The disc nucleus pulposus cutter penetrates the fibrous ring from the lateral posterior side and removes part of the nucleus pulposus tissue, so that the pressure in the intervertebral space is reduced, the nucleus pulposus tissue compressing the outer fibrous ring is reduced or eliminated, and the herniated nucleus pulposus tissue and the outer fibrous tissue and posterior longitudinal ligament are retracted and returned, thus reducing or relieving the compression on the nerve root and achieving the treatment purpose. The efficacy of percutaneous puncture discotomy and aspiration for the treatment of lumbar disc herniation is positive and similar to that of surgical treatment. The success rate reported varies from 67% to 96% due to different indications and different means of examination. The biggest advantage is that it overcomes the secondary back and leg pain caused by surgical procedures such as nerve root adhesions and epidural fibrosis; secondly, compared with surgical procedures, percutaneous aspiration is less traumatic to the body, quicker recovery, easier operation, and fewer surgical complications. However, as a minimally invasive treatment, the working cannula of percutaneous aspiration is more than 3 mm, and some of them are even more than 6 mm, so it is more blind to monitor the puncture process by X-ray TV with poor precision, and it is difficult to avoid important blood vessels, nerves and organs. Serious complications have been reported at home and abroad, such as hematoma of the psoas major muscle, injury to large vessels, nerve injury, injury to abdominal organs, and breakage of the aspiration cutter into the interstitial disc, etc. Therefore, the accuracy of its puncture relies heavily on sophisticated imaging equipment such as CT. At the same time, due to its large invasiveness, it increases the patient’s pain and greatly increases the chances of postoperative infection. Therefore, for some small and medium-sized hospitals, this treatment method is therefore difficult to gain popularity. The side effects and complications of percutaneous puncture discotomy: 1. Postoperative discitis: the incidence is about 1%. The reason for this is mainly due to the large trauma, and the structural characteristics of the disc tissue and poor blood flow resistance to infection, increasing the possibility of infection; secondly, incomplete sterilization of surgical instruments and aseptic operation, operation in non-special X-ray machine room, insufficient disinfection of indoor air, is also a factor that cannot be ignored. 2, intraoperative bleeding, injury to nerve roots, blood vessels and intestines: related to too thick a puncture needle diameter and unskilled puncture technique. 3, spinal instability: related to the large loss of medullary tissue. The advantages and disadvantages of percutaneous endoscopic discectomy (PED) have been analyzed since Hijikata proposed percutaneous discectomy for lumbar disc herniation in 1975, but the scope of application has been greatly limited due to its narrow indications. the posterior discectomy system developed in the late 1990s minimized the procedure while maintaining the traditional surgical approach. The posterior approach was also changed from a posterior lateral working triangle approach to a posterior lateral approach, and the direction of the working channel changed more freely, reducing the possible side effects of the posterior lateral approach such as nerve root and intestinal injury, and significantly expanding the indications for surgery. Since then, it has been gradually promoted. The greatest advantage of PED is its visualization. Compared with indirect decompression of nerve roots through collagenase injection therapy, percutaneous puncture discotomy and percutaneous laser disc decompression, PED can directly remove the protruding nucleus pulposus, especially the free nucleus pulposus, under direct vision, and can directly deal with lateral saphenous fossa stenosis and nerve root adhesions. In this respect, PED is superior to the above-mentioned procedures. However, as a minimally invasive procedure, PED is far more invasive than percutaneous aspiration. the working trocar diameter of PED is calculated in centimeters, and although it is less invasive than traditional developmental surgery, compared with other minimally invasive methods, posterior endoscopy is no less invasive to the body than open surgery. 1, postoperative legacy of low back pain: the larger-scale muscle trauma and the consequent muscle atrophy and muscle weakness are important causes of postoperative low back pain. PED is more traumatic and it is not easy to stop bleeding than other minimally invasive treatment methods. The chances of postoperative aggravation of nerve root inflammation and edema are greatly increased. 3. Difficulty in entering the spinal canal, damage to the dura, damage to the small intervertebral joints, and residual nucleus pulposus. IV. Analysis of the advantages and disadvantages of PLDD The use of laser for the treatment of lumbar disc herniation is another progress after chemical discolysis and percutaneous discectomy. 1984 Choy in the United States first proposed this idea, and in 1987 Choy and Ascher first reported the experimental and clinical application of non-endoscopic percutaneous laser disc decompression. Under fluoroscopic monitoring of the C-arm, a puncture needle is inserted into the cervical disc of the cervical spine lesion. Then, optical fibers are placed into the puncture needle, and the nucleus pulposus of the disc is vaporized by the thermal energy of the laser, creating a cavity, i.e., reducing the pressure within the disc and improving the nerve compression. In addition, the biological thermal effect produced by the laser radiates around the compressed nerve, improving microcirculation in the affected area and relieving nerve symptoms. PLDD avoids the disadvantages of other intradiscal decompression surgical methods such as significant soft tissue damage, extensive care, prolonged care, and a larger invasive route. However, the high cost of treatment severely limits its further use. electrodes for PLDD are expensive and can only be used once, costing thousands of dollars each. Therefore, the cost of each treatment is around 7,000-10,000 RMB, which is unaffordable for most patients in China. Especially for some small and medium-sized hospitals, it is difficult to carry out this treatment. V. Analysis of the advantages and disadvantages of medical ozone treatment for lumbar disc herniation Ozone treatment for lumbar disc herniation is a new treatment method that has emerged in the last two years. Ozone is a strong oxidizing agent. It can cause the nucleus pulposus to lose water and shrink by destroying the proteoglycans in the matrix of the nucleus pulposus, and release the nerve root compression by the herniated nucleus pulposus. Ozone also destroys the nucleus pulposus cells, causing a decrease in proteoglycan production and secretion in the nucleus pulposus. In addition, experiments have confirmed that ozone promotes the dissipation of the inflammatory process, mainly by: affecting the release of cytokine antagonists and/or self-exempt inhibitory cytokines such as IL10 and TGFβ1; causing the overexpression of antioxidant enzymes to neutralize excess reactive products; and stimulating vascular endothelial cells to produce no and PDGF causing vasodilation, which leads to the dissipation of inflammation. For the resolution of postoperative infections, the chance of infection is greatly reduced by the disinfecting effect of ozone itself. However, ozone therapy has a narrow scope of application, with a single injection of no more than 20 ml, and is only effective for mild disc herniation, while it is not effective for moderate to severe herniation, nor does it directly eliminate the nucleus pulposus tissue that compresses the nerve. One treatment is not effective and often requires 2-5 treatments to obtain a more satisfactory result. In addition, patients may experience increased symptoms after ozone injection due to the increased pressure within the disc. Ozone is more effective in relieving the symptoms of herniated discs, but less effective in treating herniated discs. Sixth, the advantages and disadvantages of intra-disc electrothermal coagulation therapy (IDET) Analysis of the above minimally invasive treatment methods are intra-disc decompression, for simple herniation or bulging patients the efficacy is certain. However, the efficacy of IDET is poor for lesions of the annulus fibrosus such as rupture of the annulus fibrosus, inflammatory factors such as substance P and phosphatase A2 on the small joint capsule, the posterior longitudinal ligament and the irritation of the tiny nerves or nerve endings on the surface of the annulus fibrosus. Therefore, inspired by the endoscopic radiofrequency treatment technique, Saal proposed in 1997 the application of thermal energy to repair and reconstruct the defective fibrous annulus, i.e., intradiscal electrothermal therapy (IDET for the treatment of Intradiscal electrothermia). IDET is performed by inserting a metallic thermal electrode (Spinc Cath) into the torn disc under X-ray surveillance, inserting a guide needle into the posterior outer part of the disc under oblique X-ray surveillance, and confirming the position of the needle tip with anterior-posterior and lateral X-rays; after the position of the needle tip is determined, the thermal electrode is inserted through the guide needle into the annulus fibrosus and treated by thermal action. IDET treatment is highly selective for patients. If the patient has significant disc herniation or spinal stenosis with symptoms of nerve root irritation, IDET is not effective; if the disc height is less than 50% of the normal adjacent disc or the discography reveals too severe a fracture, IDET is not effective; if the patient is older than 50 years old, IDET is not as successful due to the reduced repair capacity of the disc. Despite the popularity of IDET, studies have shown that the clinical results of IDET are unsatisfactory, and even reports that confirm this technique state that in the long term, only 54% of patients experienced a reduction in back pain, while only 20% were exempt from fusion. In a recent report, 50% of a group of patients at 1-year postoperative follow-up were dissatisfied with the results of treatment. This may be related to the difficulty of puncturing the IDET, which is a ring-shaped electrode, and the ideal puncture result should be to have the electrode circling along the inner edge of the fiber ring, but whether this can be achieved in practice is highly dependent on the puncture technique and the ability of the surgeon to read the film. In addition, new electrodes are needed for each IDET treatment, and if multiple disc IDET treatments are done at the same time, new electrodes must be used for each disc, because the electrodes are often creased after one use, and repeated use may cause difficulties in guiding and placing the electrodes in the disc, or even breakage. Therefore, the treatment cost is expensive, and the treatment effect is not satisfactory. Most scholars are pessimistic about its application, and believe that IDET may be eliminated in the near future when independent and objective studies are completed. The advantages and disadvantages of radiofrequency ablation nucleoplasty (NP) Radiofrequency ablation nucleoplasty, also known as low-temperature plasma ablation, is a new method of treating herniated discs that has been developed and applied in clinical practice in the past two years. Compared with the above-mentioned minimally invasive treatment methods, NP has made certain improvements in various aspects, such as smaller diameter of the puncture needle, less thermal damage, and lower treatment temperature. However, there is still little progress in the scope of treatment. For example, in patients with simple lower back pain, the symptoms mainly originate from the stimulation of nerve endings (sinus vertebral nerve). The NP cannot have a direct effect on this pathological change (rupture of the fibrous ring, endogenous nerve endings), so pain relief may not be significant. For larger herniations, heavier compression, or herniated nucleus pulposus entrapped by the fibrous ring, NP is less effective or not effective at all. Similarly, for obvious central protrusions, NP is less likely to have an effect on the protrusions, and the efficacy is relatively poor. Second, like PLDD and IDET, NP is a very expensive procedure due to the fact that the electrodes are single-use and cost several thousand dollars each. In small and medium-sized hospitals, the treatment method remains difficult to be popularized. Therefore, we believe that both intradiscal decompression for lumbar disc herniation and IDET inevitably have their therapeutic limitations, such as large trauma, safety performance to be improved, and poor selectivity of treatment. Unlike the above minimally invasive methods, radiofrequency thermocoagulation target treatment directly denatures the herniated nucleus pulposus, coagulates it, shrinks it and reduces its volume, relieves the compression, and rarely injures the normal nucleus pulposus tissue, while directly blocking the release of glycoproteins and B proteins in the nucleus pulposus fluid. The symptoms disappear or are reduced immediately after treatment. Radiofrequency targeted thermal coagulation therapy is the latest minimally invasive technology for radiofrequency treatment of disc herniation developed on the basis of the existing percutaneous intravertebral disc thermal coagulation technology (PIRFT) at home and abroad. It has many advantages over other minimally invasive therapies, such as wide indications, minimal damage, higher safety, less patient pain, higher effectiveness, lower risk, shorter treatment and hospitalization time, etc. Combining the above advantages, RF targeted thermal coagulation therapy technology has a wide promotion value.