Lumbar disc herniation (hereinafter referred to as LDH) is a common clinical disease, which is a syndrome caused by the protrusion of the lumbar disc after degeneration and rupture and compression of the spinal cord or nerve roots. The mechanism of the disease is mainly due to the degeneration of the lumbar intervertebral disc and the strong chemical stimulation of the nerve roots by glycoproteins and β-proteins released from the pulpal fluid after the rupture of the fibrous ring. Bingwen Zhou [i] demonstrated that the pH of the nucleus pulposus and the herniated disc tissue is acidic, and the authors also measured the pH in the tissue with microelectrodes and found that the painful area was also acidic, so the cause of lower extremity pain may be a tiny rupture of the fibrous ring. It is believed that in addition to nerve root symptoms caused by nucleus pulposus irritation, a sterile inflammatory response generated by fatty connective tissue and ligamentous strain in the spinal canal, and the accumulation of released chemicals can also be caused. And it is believed that mechanical compression alone can only produce sensory abnormalities of numbness in the affected limb. Therefore, timely release of nerve root compression, or elimination of non-specific inflammation and reduction of local acidosis, is required to relieve this radicular pain from the etiological aspect. During the clinical practice in the intervertebral disc area of Chengdu Sports Hospital, it was found that the number of patients with LDH is increasing and tending to be younger, and the youngest patient I saw was only 12 years old. (2) numbness of skin sensation in the distribution area; (3) 50% reduction in straight leg elevation test compared to normal, with or without positive elevation test, and radiating pain in the distal and proximal extremities caused by finger pressure on the tibial nerve in the N fossa region; (4) two of the four neurological signs (muscle atrophy, motor weakness, hyperalgesia and reduced reflexes); (5) imaging findings consistent with clinical examination, such as CT, etc. 2. 2.1 Non-surgical treatment 2.1.1 Oral and sedative drugs Corticosteroids: such as dexamethasone, trenbolone, lidocaine, etc. Non-hormonal class: such as colchicine, fenpropathrin, salvia injection. Muscle relaxants: such as clozoxazone. Other vitamins such as B6, B12, etc. These drugs have some efficacy in some mild cases of LDH. 2.1.2 Complete bed rest The effect is to relieve the pressure of weight on the disc, so that the affected part is stationary, thus accelerating the inflammation and disc retraction. This method must be absolutely lying on a hard bed for more than 3 weeks, even if meals and urination and defecation, can not sit up, after 3 weeks can get up to tie the waist circumference for 3 months. No flexion of the waist and no physical work above medium level for six months. This method can make early lesions and mild patients get cured or alleviated. Because this method is simple and non-invasive, it can still be a necessary therapy for early and mild cases. 2.1.3 Traction therapy is a commonly used method to reduce the internal pressure in the intervertebral space, force the bulging disc to flatten, tighten the ligamentum flavum and joint capsule, and expand the volume of the spinal canal. The methods include continuous traction method, two-end traction kidney pad repositioning method, self-gravity suspension traction method, vigorous horizontal brief traction and instant violent traction. The commonly used method is continuous traction, traction weight from light to heavy, but not more than body weight, 2-3 times a day, each time 0.5-1 hour, 2-3 weeks for a course of treatment. However, Shao Xuan et al[ii] concluded that traction weight not exceeding 15 kg can be tolerated by patients for a long time without causing muscle spasm, leaving the spinal muscles in a relaxed state and achieving partial elongation of the ligamentous fibrous rings. Lv Yusheng et al [iii] showed that traction force increased the intervertebral space volume by 10 kg of body weight or more than 10 kg of body weight, and over 20 kg of body weight, not only did not continue to increase the intervertebral space volume, but on the contrary, the value was smaller than the first two, and the patient was uncomfortable during traction, which may be related to the excessive traction force, which stimulated the proprioceptors located in the ligaments around the small joints of the spine and caused reflex muscle contraction against This may be related to excessive traction, which stimulates the proprioceptors located in the ligaments around the small joints of the spine, causing reflex muscle contraction against traction. A pillow is placed in the lower lumbar region between the L3 and L5 lumbar vertebrae during traction, so that the spine is in a posterior extension position, which is not only conducive to retraction of the protrusion, but also to repair. Some authors believe that traction position with slight forward flexion of the waist is appropriate. 2.1.4 Physiotherapy and massage Using traditional techniques, the spine can be flexed, extended and rotated to relax the spastic muscles and reduce the harmful stress on the intervertebral disc. Gong Zhengfeng et al [iv] performed spinal massage therapy under dulcolax analgesia and mechanical traction (about 110% of body weight) with a significant efficiency of 71%, and concluded that various manipulations may cause the herniation to be displaced, deformed and thus relieved the pathological effects of the herniation on the nerve root or dural sac to varying degrees, and whether the herniation can be retracted is not the only factor determining the efficacy. Fu Xubing [v] treated 50 cases of LDH with lumbar traction with ultrashort wave, with a total efficiency of 94%, and concluded that LDH symptoms are related to paravertebral tissue inflammation, and that ultrashort wave improves blood and lymphatic circulation in deep tissues, vasodilation, accelerated blood flow, and increased tissue permeability, accelerating inflammation absorption. However, cases of bleeding, fracture dislocation and paraplegia caused by Tui Na massage have also occurred from time to time. There have been reports of massage causing hematoma under the L4-5 posterior longitudinal ligament and cauda equina nerve damage, resulting in loss of sensory function in the lower limbs. Therefore, the indications for tui na massage should be mastered. Through mechanical traction [traction force generally in 30-60 kg according to the patient’s age and ability to withstand] and the placement of Chinese medicine fumigation each 30 minutes once a day, medium frequency electrotherapy in the lesion each 20 minutes 10 times a course of treatment, manipulation of the lumbar relaxation by massage and kneading points, with side wrench, leg lifting pressure waist, sit-to-stand rotation, back method and other reset, the cure reached 72.1% total effective rate of 98.7%. In the literature,[vi] those who are not suitable for manual treatment are: (1) dead bone type with long duration of disease; (2) “cauliflower type” with a small tip and bulging end of the protrusion; (3) “prolapse type” with a long oval shape, hard texture and uneven height of the protrusion; (4) fibrosis (4) the “free type” in which the annulus ruptures completely and the herniated fragments are free in the spinal canal and nerve root canal; (5) the “osteochondral type” in which the herniated calcium salt deposits, osteophytes, bony and cartilaginous protrusions are formed; (6) the central type with nerve root damage, lumbar spinal canal stenosis and older people. 2.1.5 Chinese herbal medicine treatment According to Chinese medicine, LDH belongs to the category of lumbar and leg pain and paralysis, which is mostly caused by the deficiency of liver and kidney qi and blood, external injury to tendons and bones, internal blockage of qi and blood by silt and blood, or external attack of wind, cold and dampness to block the meridians and channels, resulting in the imbalance of yin and yang of the body. Therefore, the principle of treatment is to benefit the kidney and cultivate the root, activate the meridians, activate blood circulation and remove blood stasis, so that the meridians can flow smoothly, blood and Qi can flow, cold can be dispersed and damp can be removed, so as to achieve the effect of strengthening the kidney and bone, removing blood stasis and relieving pain, and treating both symptoms and root causes. There are many Chinese herbal formulas and proprietary Chinese medicines for the treatment of LDH, such as the traditional meridian formulas of Tao Hong Si Wu Tang, Blood Mansions and Stasis, and Wu Tou Tang, etc. Externally, there are Bai Wu Luo Ointment and Musk Rheumatism Ointment. Chinese herbal preparations are easy to prepare, effective, painless and easy to accept by patients, and without serious systemic adverse reactions. 2.2 Treatment between non-surgical and surgical [limited surgery] 2.2.1 Sacral canal closure The sacral canal is the sacral part of the epidural cavity, and sacral canal closure is injected by the sacral fissure. Most of the dura stops at the second lumbar vertebra, so the closure is not easily injected into the subarachnoid space and is safer. Hu Yougu [vii] believed that epidural cavity injection of anesthetic drugs and a small amount of hormones can inhibit the excitability of nerve endings, while improving local blood circulation, so that local metabolites are easily taken away from the blood circulation, reducing local acidosis, and blocking the vicious cycle of pain, thus achieving the purpose of anti-inflammation and pain relief. Liu Chunhe et al[viii] applied sacral injection drug to treat 85 cases of intervertebral disc herniation, and 78 cases were effective, with rapid injection after successful sacral puncture. 1 week closure for those who relapsed within 1 week, 3 days for those who relapsed in 2-3 days, and 1 time per day for complete relapse of symptoms within 1 day, with 4-8 times as 1 course of treatment. The treatment mechanism is firstly, local anesthetic drugs to block the vicious cycle of pain, and secondly, the “liquid stripping” and flushing effect of rapid drug injection on nerve roots and the anti-inflammatory and nutritional effects of hormones and vitamins. Hu Shibin [ix] used 10 ml of Chinese patent medicine compound Danshin solution instead of coenzyme A and ATP for sacral drip. They believed that, in addition to the “liquid stripping” effect, the large dose of liquid administered by drip in the sacral canal may also play the role of “hydraulic force transmission” during the repositioning and strengthen the therapeutic effect. Yang Liucai [x] and others concluded that there are 35 kinds of drugs divided into 7 categories: 1: local anesthetics + hormones, 2: local anesthetics + hormones + nutrition [hereinafter referred to as 2], 3: 2 + vasodilators, 4: 2 + Danshen Chinese medicine, 5: 2 + enzyme preparations, 6: 2 + energy synergists, 7: 2 + alkalizing drugs. Indications for selection: 1, short onset of pain with a high degree of severity 2, long duration of the disease with acute episodes of recurrent low back pain 3, recurrence after disc surgery 4, CT showing protrusion below 0.5 cm without spinal stenosis. 2.2.2 Epidural or subarachnoid anesthesia Chen Jian [xi] injected 20 ml of 2% lidocaine and 125 mg of prednisolone after successful epidural puncture, and performed manual pushing after lying down for half an hour, and the treatment excellent rate was 79.1%. Fu Jiezhen[xii] performed manual therapy after successful epidural anesthesia and kept the epidural tube back to the ward to continue drug injection, the drug composition was prednisolone 2.5ml and 0.7% bupivacaine 5ml, the sick person added morphine 1mg, once a day, the third day to change the prednisolone to conningkatone 40mg, after the injection was removed. A total of 20 cases were treated, and all the symptoms of lumbar and leg pain disappeared or were significantly reduced, the straight leg raising test was negative, and the lumbar activities were normal. Zhang Shimin et al[xiii] simply applied 10ml of chloroquine for epidural injection once in 2 weeks, treating 26 cases, with an excellent rate of 80.8%, and proved through animal experiments that Chinese medicine chloroquine used for epidural injection has no irritation, has no effect on the ligamentum flavum, dura mater, arachnoid and spinal cord, and can avoid the side effects brought by the application of hormones. Sun Yiqiang[xiv] used 3-day continuous epidural administration to treat severe LDH with a total efficiency of 100%, emphasizing that this method is preferred to treat cases with short duration of severe pain and the affected area with inflammatory edema as the main contradiction for numbness is mainly ineffective. 2.2.3 General anesthesia or analgesia When Jinhua et al[xv] used traditional Chinese medicine tuina techniques under general anesthesia to treat lumbar disc herniation, they believed that general anesthesia could really achieve muscle relaxation and painlessness, and partially or even completely reset the nucleus pulposus at one time, which is suitable for recalcitrant lumbar herniation that is invalidated by general tuina. Chen Ji’an et al[xvi] performed traction massage 5-10 minutes after applying 50% dextrose 60 ml plus pethidine 1 mg/kg or fentanyl 10-20 mg/kg. It is believed that the side effects of intravenous anesthesia and intravertebral anesthesia can be avoided, and its analgesic method, although it does not have a complete analgesic effect, has the greatest characteristic of safety and better cooperation between the patient and the physician during the maneuver. Whether it is epidural anesthesia, lumbar anesthesia or general anesthesia, a thorough preoperative examination should be conducted, and emergency drugs and equipment should be routinely prepared during the operation, and only experienced anesthesiologists should be used to complete the procedure. 2.2.4 Local nerve root closure The application of injection needle puncture for intervertebral foraminal anesthesia is simple, selective, and easy to cooperate with awake patients, and it is used with caution for central disc herniation. However, Zhou Linkuan et al[xvii] treated 30 cases of central disc herniation with light manipulative massage under this anesthesia, and 21 cases were effective. This indicates that the deficiency of analgesic modality can be compensated by different manipulation. Tang Kaijun[xviii] et al. treated LDH with nerve root compression injection and sciatic nerve pulling, the mechanism of which is that nerve root release injection therapy allows the drug to act directly on the nerve root and the drug can also penetrate through the intervertebral foramen into the epidural cavity or the inflammation around the herniated disc, relieving the symptoms of pain. 2.2.5 Acupuncture Acupuncture can harmonize qi and blood, unblock the meridians, resolve blood stasis and relieve pain. tonify the liver and kidney. Studies have confirmed that acupuncture can reduce the excitability of nerve endings, promote muscle relaxation, relieve muscle spasm, dilate peripheral blood vessels, improve blood circulation at the lesion site, promote local metabolic mechanisms, increase pain-inhibiting substances or transform pain-causing substances, and increase the pain threshold, so the antispasmodic and analgesic effect can be achieved. Wang Jinliang[xix] used acupuncture with rotational repositioning to treat 100 cases, and the efficiency was 100%. The method is to take the affected vertebrae on both sides and open 3 inches (experience point), after getting the qi, perform strong stimulation, keep the needle for 7-10 minutes and then withdraw the needle, then perform manual treatment, once a day, 7 days a course of treatment, interval of 3 days. Li Jungong [xx] took the following points: lumbar Yangguan, under the 17 vertebrae, affected side of the large intestine, Chibian, Huanjiao, Yinmen, Zhizhong, Chengshan, Kunlun. In 60 cases, 33 cases were cured, 18 cases improved, and 9 cases were ineffective, with an overall efficiency of 85%. In the conservative treatment of more than 30 patients with LDH, the author considered that taking the points of lumbar eye, lumbar pinched spine, rank side, committee center, Chengshan and Yanglingquan was effective. 2.2.6 Chemolysis of the nucleus pulposus This method injects papaya rennet or collagenase into the nucleus pulposus to make it break down and shrink and reduce the compression. In 1968, SUS SMAN treated 29 cases of this disease with local injection of collagenase. The follow-up was more than 12 months, with an excellent rate of 60-90%. BOCCANERA conducted a 1-3 year follow-up of 60 patients who underwent papain nucleolysis. 20% of patients had lower back pain or spinal stiffness after surgery, 5.4% had persistent contralateral sciatic N pain, and 2% had worsening transient sciatica, of which the most dreadful complication was the formation of paraplegia secondary to enzyme misinjection into the spinal canal. Li Dalian [xxi] randomly divided 104 patients with unilateral percutaneous herniated discs into two groups for percutaneous percutaneous discotomy and aspiration, 42 cases in the unilateral percutaneous discotomy group (grade A) and 68 cases in the biphasic percutaneous discotomy group (group B), with a postoperative follow-up of 6-18 months, and a cure rate of 76?2% for grade A and 95?6% for grade B, indicating that bilateral percutaneous discotomy and aspiration for LDH than unilateral discectomy and aspiration. Wu Zailiang[xxii] believed that postoperative pain, nerve root injury, lumbar spinal stenosis and other complications resulting from the injection limited the promotion and application. 79 cases of lumbar disc herniation were treated with two methods of extra-disc collagenase injection from September 1997 to March 1999. The results showed that 77% of the cases were excellent at 7 days after surgery and 88% were excellent at more than 6 months of follow-up as judged by the Chinese Orthopedic Spine Surgical Assessment Criteria for Low Back Pain. Liu Guohui [xxiii] showed poor outcomes in 142 cases after collagenase lysis in 980 cases over a 5-year period, for which CT and MRI examinations and surgical exploration revealed 28 cases of herniation or prolapse, 34 cases of ossification of the posterior longitudinal ligament, 52 cases of spinal canal stenosis, 18 cases of nerve root canal stenosis, and 14 cases of spinal degeneration instability, and the results were analyzed for long-standing disc herniation with significant ossification, significant spinal canal or nerve root canal It has the advantages of small trauma, no bleeding, no interference in the spinal canal, and safe, effective and fast recovery, which has been welcomed and accepted by both doctors and patients, and can still be changed to surgery after failure, and is widely used clinically, but strictly following the indications is the method to improve the efficacy. 2.2.7 Small needle knife method The massage of LDH patients found that the patient’s posterior iliac spine, above the outer sacroiliac fascia and the medial edge of the sacrospinous muscle next to L4-5 vertebrae can be palpated with sticky strips and mechanized materials, which is thought to be caused by LDH causing passive lumbar scoliosis or arching of the back, which causes edema and degeneration of the fascia and related tissues for a long time, and the use of small needle knife relaxation to cut and peel to relieve pain has a positive effect on promoting the relief of the disease, and the operation Pay attention to aseptic operation and nerve injury. 2.3 Surgical treatment 2.3.1 Conventional surgery Jin Anmin [xxiv] conducted a long-term comparative study of three types of lumbar disc herniation removal (hemilaminectomy, total laminectomy and laminectomy), taking 300 cases of laminectomy, 40 cases of hemilaminectomy and 30 cases of total laminectomy from 1983 to 1985. It was concluded that total laminectomy has the worst efficacy and the highest postoperative complications, and should be avoided. In contrast, small-incision laminectomy has the advantages of small incision (about 4 CM), less injury, less bleeding (20-100 ML), faster recovery, better efficacy and fewer complications, and is worth advocating. Chen Xiannan [xxv] analyzed 19 cases of re-operation of LDH admitted to our hospital from January 1996 to December 1999, and concluded that negligence of clinical examination, lack of routine X-ray, blind reliance on CT or MRT to establish the diagnosis and unclear preoperative diagnosis led to surgical failure. Guo Ting [xxvi] compared the methods of total laminectomy or bilateral laminectomy for central type LDH, and the excellent rate of total laminectomy reached 84% and the excellent rate of bilateral opening reached 87%, and the method of bilateral laminectomy is generally advocated, which can preserve the posterior lumbar structures with less trauma and faster patient recovery and avoid the lumbar instability brought about by total laminectomy. Although surgical treatment follows the principle of decompression and stabilization and can achieve nerve root release and decompression, the disadvantage of more complications such as postoperative lumbar instability or postoperative lumbar back disease and sciatic neuropathy due to adhesions and scarring of the lumbar instability remains unresolved. 2.3.2 Percutaneous puncture lumbar disc removal (PLD) and percutaneous discoscopic direct view disc removal (AMD) In 1975, HIJIKATA first used percutaneous puncture PLD to open up a new pathway between surgery and conservative treatment, but the above is only suitable for simple and acute LDH and has poor efficacy for its combined intervertebral stenosis or root stenosis. In 2001, Yi Yong [xxvii] carried out 5 cases of this type of surgery, 2 of which were unsatisfactory, postoperative pain and signs still existed, 1 of which was better with conservative treatment, the other case had a tendency to worsen, conservative treatment was ineffective, and the surgery was repeated in 4 months after the surgery, during which the L4?5 nucleus pulposus was found to be herniated and fell into the spinal canal near the level of L5?S1 disc, with extensive adhesion to the spinal stenosis, the excellent rate of this group was only 60% In 2000, Ren police [xxviii] reported that 210 cases of LDH were treated surgically since October 1992, with a follow-up of 3-5 years, the results showed that 140 cases recovered well after surgery, accounting for 67%, and 70 cases had poor results accounting for 33%, of which surgical treatment was changed due to poor results. Luo Yuchun>[xxix] believed that three cases of central type one is no lower limb symptoms only lumbar symptoms are not its indications two is a central type but the symptoms are manifested on one side feasible AMD three is a central protrusion double lower limbs have symptoms feasible AMD, LDH surgery and then surgery is a contraindication to AMD. 2.3.3 Artificial prosthesis replacement Although lumbar discectomy is widely used, the surgical efficacy is still between 70 -80%, apparently unable to solve the surgical hand joint instability, of accelerated its degenerative changes, years or decades after surgery, lumbar disease or neuropathy, especially fusion of more than two segments more, and some lesions form pseudo-joints, people try to replace the symptom-causing disc with artificial prosthesis, providing similar stable activities and weight-bearing function, Liu Shangli [xxx] applied a modified SB CHARTE type III artificial disc for lumbar disc replacement from April 1998 to April 2000, with a 2-year follow-up, and the postoperative lumbar segments could be averaged 4.0 degrees of forward flexion and 5.1 degrees of posterior extension, 1 then had mild displacement due to technical reasons, but no clinical symptoms. Wang Qingyi [xxxi] applied SB CHARITE III disc for lumbar disc replacement from December 1999 to November 2001, with a follow-up of 4 months to 2 years and 3 months, averaging 16.7 months, with an improvement rate of 89% in symptoms and 84% in patient satisfaction, with satisfactory short-term results, but long-term results to be However, the long-term effect needs to be further observed. Dai Xiangqi believes that the long-term efficacy of artificial disc replacement cannot be determined, and no artificial prosthesis has been produced to meet the biomechanical structure of the national population, especially how long the implant can be maintained, and the exact indications of this technology need to be further studied, so caution should be exercised when choosing this method. 3.Summary and suggestions In summary, there are many treatment methods about LDH, and the effect is not the same, conservative treatment of lumbar disc herniation is certainly effective, its analgesic methods are diverse, the author believes that the full use of acupuncture, massage and other easy-to-operate methods with little risk and obvious effect, the composition of drugs also varies from family to family, it is believed that the characteristics of Chinese medicine with long efficacy and small side effects can be given full play to partially or fully replace hormonal drugs. Some people have proved through clinical comparison studies that the therapeutic effect of epidural injection or traction, acupuncture and moxibustion is worse than the combined treatment of the two, and it is advisable to use them together in clinical practice to achieve better therapeutic effect. Although conventional surgery is technically mature, post-surgical recovery and complications have not been well solved. Minimally invasive surgery has the advantages of safety, effectiveness, little damage and fast recovery, and has the development direction of contemporary surgery, but it is impossible to treat all types of LDH by any one method. The advantages of easy operation, less pain and clear effect of acupuncture and traditional Chinese medicine, and the choice of surgery can be made according to the surgical indications if conservative treatment is ineffective for more than three courses. In the choice of surgery, minimally invasive limited surgery has become the mainstream, showing the good development prospect of minimally invasive surgery.