It has been more than 70 years since Mixter surgically confirmed that herniated lumbar disc compression is the cause of sciatica, and it should be more than 60 years since surgical removal of the disc or surgical decompression was performed in the clinic. Although there are many clinical treatment methods, the treatment method aimed at relieving the nerve compression is still the most readily accepted traditional philosophy of lumbar disc herniation treatment. However, with the progress of research on disc pathophysiology and spinal mechanics, as well as the development of therapeutic drugs, imaging medicine and treatment devices, the diagnostic classification of lumbar spine lesions has become more accurate, and the introduction of the concepts of discogenic lumbar pain and lumbar disc disorders has not only enriched the understanding of the disease, but also made the treatment more targeted. The treatment of lumbar disc lesions is also developing in the direction of minimally invasive treatment that reduces trauma and protects function. The comprehensive and systematic understanding of minimally invasive lumbar disc treatment technology by domestic and foreign scholars in the past decade or so has not kept pace with the development of minimally invasive treatment technology. The clinical phenomenon of expanding indications or non-standardized application affecting the therapeutic effect and causing adverse events deserves our serious consideration. What is the fundamental purpose of clinical technology? For the technology itself? Or is it the therapeutic goal? These technologies in general seem to face the same problem, so what are the criteria for the selection of these technologies? It should be said that the very emergence of this approach illustrates the limitations of a single therapeutic approach in the treatment of lumbar disc herniation. Each of these different treatment mechanisms has its own technical characteristics and advantages, so how should clinicians master them in order to break through the limitations and thus take advantage of these techniques? Through retrospective study and our clinical observation, we have made a preliminary discussion on the indications, contraindications and complications, application methods and evaluation of long-term efficacy of minimally invasive interventional techniques for lumbar discs that are currently widely used in clinical practice. Basic principles of minimally invasive interventional treatment for lumbar disc herniation Indications: Patients with a clear diagnosis of lumbar disc herniation by clinical history, symptoms, signs, CT and/or MRI with consistent images of symptoms and signs. Also no obvious contraindications: except for the combination of other diseases, more than 4 weeks of disease duration, and poor results of standardized conservative treatment. Contraindications: combined cauda equina injury, uncontrolled metabolic disease, bleeding tendency, discitis or intervertebral space infection, bony spinal stenosis or foraminal stenosis, ossification of the posterior longitudinal ligament, hypertrophy of the ligamentum flavum, calcified or free disc, pregnant women and children under 14 years of age, and those with psychological or psychiatric disorders. Standardized preoperative preparation, clear and definite responsibility for the intervertebral disc, strict indications, and preparation of the patient’s general condition. Preoperative training in bed for urination and defecation; and preoperative decontamination, etc. I. Lumbar intervertebral disc chemolysis: 1. Mechanism: collagenase hydrolyzes collagen fibers, acting on all 3 alpha-chains of the collagen molecule, 3/4 of the way from the amino acid end, hydrolyzing the collagen molecule into 3/4 and 1/4 fragments, which are eventually degraded to the relevant amino acids under the action of other protease hydrolases and are neutralized and absorbed by plasma. As the total volume of the intervertebral disc is significantly reduced, the herniation is thus reduced or disappeared, the compression on the nerve tissue is relieved or eliminated, and the clinical symptoms are improved or disappeared. Collagenase can also have a significant inhibitory effect on the activity of pain-causing inflammatory mediators (PLA2), which has a therapeutic effect on the inflammation of lumbar spinal nerve roots. 2.Puncture injection method: Combine with the morphology of protrusion and anatomical characteristics of the spinal canal, carefully select the puncture method and pathway, and follow the basic requirement of “medicine reaches the disease, enzyme reaches the substrate”. Puncture under imaging surveillance. The method of injecting injectable collagenase into the nucleus pulposus or annulus fibrosus of the herniated lumbar disc is the intradiscal method. The method of injecting collagenase around the nucleus pulposus of the herniated lumbar disc is known as the extradiscal method. The extradiscal method is divided into the anterior epidural space and posterior epidural space methods (which are no longer commonly used). The anterior epidural space method is divided into four methods depending on the local anatomy and the access route: 1) the bypass method in which the needle is inserted through the intervertebral foramen safety triangle to the herniated nucleus pulposus; 2) the anterior sacral canal fissure method in which the tube is inserted through the sacral canal fissure from the anterior epidural space to around the herniated nucleus pulposus; 3) the anterior epidural space method in which the needle is punctured through the external incision of the vertebral plate or the internal margin of the lesser joint to the lateral saphenous fossa; 4) the posterior epidural space method in which the needle is inserted through the spinous process to the herniated nucleus pulposus (4) The anterior epidural space method in which the needle is inserted from the posterior epidural space through the spinous process to the peri-neural nucleus. Different methods are chosen for different morphology and anatomical features of the spinal canal. If an extradiscal injection is performed, a local anesthetic injection test must be performed. If necessary, contrast injection should be performed to observe the diffusion pattern and direction of the contrast agent in order to determine the amount and volume of collagenase injection. In general, the extra-disc injection should not exceed 1200U/3ml, and the intra-disc injection should not exceed 300U/0.5ml. 3. Postoperative management: routine postoperative antimicrobial treatment for 3 days, strict bed rest for 5~7 days. Intradiscal injection high pressure period management (aggravation of lumbar and leg pain, abdominal distension, constipation, urinary retention, acute nerve root entrapment, etc. The patient should be protected by a lumbar girth after getting up to reduce the risk of acute nerve root entrapment due to reherniation of the disc. Provide necessary rehabilitation instructions to the patient and the patient’s family after getting up, and establish a method of post-discharge follow-up contact. Early low back rehabilitation is an important measure to reduce postoperative low back. 4, near and long-term results: most reports and a large number of clinical observations show that the efficiency is 90％ or more. 5.Complications: nerve root damage, infection, etc. Drug misinjection into the subarachnoid space can lead to serious complications and even patient death. Second, the lumbar disc herniation radiofrequency thermal coagulation treatment mechanism: the heat generated around the electrode causes the nucleus pulposus to solidify and shrink, repairing the fibrous ring or destroying the nerve endings within the fibrous ring of the hyperplasia migration, changing the internal environment of the intervertebral disc. Radiofrequency thermal coagulation has been one of the fastest growing technologies in recent years. At present, there are four main types of lumbar intervertebral disc lesion treatment as follows. (A) monopolar target radiofrequency thermocoagulation 1, mechanism: intervertebral disc radiofrequency thermocoagulation (PIRFT): treatment by radiofrequency electrodes placed in the posterior nucleus pulposus of the intervertebral disc. Most of the literature reports its long-term effect is not good, in recent years more many clinical workers by changing its role site to pursue the effect, emphasizing the target tissue (protrusion) radiofrequency thermal coagulation, in the clinic to achieve better results. 2, relative indications: rupture of the annulus fibrosus, nucleus pulposus tissue prolapse, disc herniation combined with spinal stenosis, this technology can also be carried out cautiously, if necessary, combined with chemical lysis. 3.Operation method 1）Puncture approach selection For lateral type herniation, most of them adopt the approach of the inner edge of the small joint on the same side; for central posterior herniation, the posterior median approach can be used; for extreme lateral type herniation, the approach of the intervertebral foramen safety triangle is used. (2) Preoperative preparation: the general preparation is the same as that of lumbar disc chemical lysis, and the relationship between lumbar disc herniation and nerve root should be fully analyzed before surgery, and the working site of radiofrequency electrode puncture and the length of the working bare end of radiofrequency electrode and basic working parameters should be determined in combination with the penetration approach. (3) Puncture method Basically the same as lysis, the operation is injected to protect the insulating coating of the penetration needle. (4) Radiofrequency parameters and methods After the penetration needle is determined to reach the target point of the herniated disc by image monitoring, the radiofrequency electrode is placed, and the radiofrequency instrument shows that the impedance is mostly between 150-300Ω (nucleus pulposus tissue), and the sensory and motor evoked detection is carried out successively, and the lower limb pain and lower limb muscle contraction cannot be evoked. After confirming the location of the electrode target, radiofrequency thermoplasty was started. Generally, the working parameters are 70 oC and 60S at the beginning, and then gradually increased to 80 oC and 60S, at which time more symptoms such as heat, swelling and pain in the lower back and legs can be replicated, and no electric shock-like numbness and pain can occur. Thereafter, the parameters will be set at 90 oC, 90S and work for two cycles. Throughout the radiofrequency thermoplasty, pay attention to the intraoperative pain changes of the patient, when the patient appears intolerable heat burning pain, stop radiofrequency thermocoagulation in time, check the nerve function of the patient’s lower limbs, and prevent the occurrence of nerve injury. 4. Postoperative management: Most patients can get relief of symptoms after surgery, and the straight leg raising test is improved compared with that before surgery. If the patient had strong burning pain in the lower extremity during the operation, routine dehydration for 3 days after the operation, and vitamin drug treatment. Postoperative antimicrobial therapy was routinely administered for 3 days. 5. Recent and long-term results: There are not many reports in the literature. In our department, 292 cases were treated in the past 5 years, and the efficiency rate reached 95％ at the time of discharge. 53 cases were followed up for more than 6 months, and the excellent treatment rate was above 90％ among them, 40 cases had reduced morphology, and some cases the protrusions basically disappeared. 6, complications: infection, bleeding, injury is the clinical to be concerned. The literature has not seen special reports. (B) intervertebral disc plasma radiofrequency ablation myeloplasty 1, mechanism: the application of 100KHz radiofrequency energy, in the local tissue around the electrode to produce a plasma area, so that the surrounding tissue molecular chain impact and break and the formation of elemental molecules and low molecular gas (O2, H2, CO2, etc.), and released through the cannula, thereby reducing the internal pressure of the intervertebral disc. 2. Operation method: Take a prone position and puncture in the safety triangle. Under the monitoring of C-arm X-ray machine, a 17-gauge trocar needle is placed into the intervertebral disc at an angle of 45° to the sagittal plane, and X-ray imaging is performed in a satisfactory position with the tip of the needle entering the disc 1~1.5cm in both the front and side positions. After the puncture is in place: the special working rod connected to the plasma surgery system is inserted into the intervertebral disc along the puncture trocar needle under the surveillance of the C-arm X-ray machine, and the ablative cutting energy is set to 4 gears, and the ablation mode is activated, and the working rod is moved from shallow to deep to the deepest depth; the curing mode is activated, and the working rod is gradually retreated to the shallowest point; in the six directions of 2, 4, 6, 8, 10 and 12 points within the intervertebral disc, the working rod is moved Repeat the above process for ablation and curing of the nucleus pulposus for about 3 min each. During the operation, observe the patient’s reaction and communicate with the patient in a timely manner. If the ipsilateral waist or lower limbs twitch or become numb during the operation, suspend the vaporization and adjust the direction and depth of the vaporization rod or dry the blood on the vaporization rod before performing the operation again. 3.Complications: nerve injury, infection, bleeding. 4, near and long-term results: dozens of recent domestic reports efficiency in 74-97.5％, there is no large sample size long-term follow-up data. (C) bipolar water-cooled radiofrequency fibrous annuloplasty 1, mechanism: two electrode needles are placed at the location where the posterior edge of the lesioned disc fibrous annulus and the nucleus pulposus meet. When the electrode needle enters the outer edge of the nucleus pulposus, the radiofrequency current is used to form an extensive radiofrequency destruction zone around the two electrode needles, and a cooling water circulation pathway is built into the electrode needles, so that cooling water is constantly passed through the whole needle without increasing the temperature. More than 42℃, no damage to the spinal nerve. Through the thermal coagulation effect, the pressure of the intervertebral disc is reduced; radiofrequency energy is used to repair the fibrous annulus and perform fibrous annuloplasty; radiofrequency thermal coagulation destroys the disease-causing nerve in the intervertebral disc. 2.Operation method: 1）Positioning puncture: the same as discography puncture. Key points: perform bilateral puncture of the same segment of the disc; the tip of the needle is located at the junction of the annulus fibrosus and the nucleus pulposus. The ideal entry point is when the electrical impedance shows 200-300 ohms and the image is orthogonal to the level of the articular eminence. At the same time, the tip of the puncture needle should not touch the cartilage plate of the upper or lower vertebral body. (2) Connection: Two treatment electrode needles with built-in cooling pathways are connected to the host computer and the cooling water pump that is complementary to the host computer. Each electrode has a circulating cooling water input and output at the end of the electrode, which is connected to the infuser of the pump through a connector, and each infuser is filled with 70ml of sterile saline. the pump is connected to the RF mainframe through a transmission line, and the mainframe regulates the temperature of the tissue around the RF electrode by adjusting the input speed of the circulating cooling water through the temperature sensor at the tip and exposed end of the electrode. Radiofrequency thermal coagulation: using standard radiofrequency mode 70℃, 2 times continuously for 90 seconds. 3.Postoperative management: unipolar target RF thermocoagulation. 4, efficiency: there is a lack of large-scale clinical randomized controlled studies, one literature reported postoperative pain score 95％ patients had relief, Oswestry questionnaire score 23.3 ± 7.0 improved to 16.5 ± 6.8, SF-36 functional score 51 (18) improved to 70 (16) (Kapural et al). (D) Radiofrequency electrothermal coagulation of the intervertebral disc IDET: 1. Mechanism: local thermal therapy produced by thermal coagulation through U-shaped thermal resistance electrodes causes the collagen fibers in the fibrous annulus tissue to contract and remodeling may occur to heal the tear. Inactivate the inflammatory factors and degrading enzymes in the intervertebral disc, thus eliminating chemical pain-causing factors. At the same time inactivate the nociceptive nerve endings distributed in the outer layer of the annulus fibrosus so that it loses the ability to receive and transmit pain signals 2, indications: consistent with bipolar water-cooled radiofrequency fiber annuloplasty. 3.Operation method: Puncture through the intervertebral foramen in the safety triangle and carefully cross the intervertebral foramen until entering the outer fibrous ring. On the posterior anterior view, the trocar needle enters the intervertebral disc until the tip is projected on the medial side of the pedicle. On a lateral view, the tip should be in the center of the disc. The bendable electrode is guided by the trocar needle across the disc, then posteriorly and finally inwardly past the posterior portion of the annulus fibrosus. The exposed portion of the electrode is made to pass as far posteriorly as possible through the posterior annulus fibrosus without breaching it. Once in place, the electrode is first heated rapidly to 65°C, increasing the electrode temperature by 1°C every 20-30 seconds, and then gradually to 85-90°C for 4 minutes. Intraoperatively, the patient’s pain can be occasionally replicated. 4. Postoperative management: basically the same as targeted radiofrequency thermocoagulation. Postoperatively, patients are encouraged to walk to do light lower limb stretching exercises. Avoid excessive lumbar flexion sedentary, etc. Low-intensity stabilization exercise will be started in the second month after surgery. No sports activities should be performed within 3 months after surgery. 5. Efficiency: The vast majority of the literature reports only short-term results. Boduk31 reported the evaluation of 35 patients who underwent IDET for IDD with a case-control follow-up of 12 months. The outcome assessment methods used were visual analogue score (VAS), time to return to work, opioid use and Oswestry Disability Questionnaire (ODQ). Data were collected at March, June and December. Within 3 months postoperatively 23％ pain was completely resolved and 60％ relieved. At 3 months postoperatively, only 50％ pain remained largely relieved scattered.Saal and Saal44 reported early results in 58 patients with a minimum 2-year follow-up. Using a change in SF-36 score of 7 or more before and after treatment as a criterion for “success, “45 the success rate of IDET surgery was 71％ …… 6. Complications: catheter rupture, nerve root injury, progressive disc degeneration, cauda equina nerve syndrome, infection, vertebral endplate osteonecrosis, epidural abscess, radiculopathy, lumbar disc herniation, spinal cord injury. Laser vaporization and decompression of the intervertebral disc 1. Mechanism: laser vaporizes part of the nucleus pulposus of the intervertebral disc to reduce the pressure and height of the intervertebral disc to achieve the purpose of decompression of the dural sac and nerve roots; inhibits the release of inflammatory mediators in the intervertebral disc. 2, Method: Generally puncture through the intervertebral foramen safety triangle, very few patients with L5S1 dural sac outer edge and small joint inner edge gap can be punctured through the small joint inner edge while avoiding the nerve roots. When the X-ray imaging shows that the puncture needle is located at the posterior edge of the vertebral body, in the middle and posterior 1/3 of the intervertebral space in the lateral view, and between the internal edge of the small joint and the internal edge of the spinous process in the orthogonal view, it is more ideal. The laser power is set at 8-12 J, the pulse time at 1 S, and the pulse interval at 1.0 S. The total laser energy is controlled at 800-1500 J. During the vaporization process, the fiber should be withdrawn intermittently for decompression to reduce the pain and discomfort caused by the sudden pressure rise in the intervertebral disc due to gas accumulation, and the depth of the puncture needle and fiber should be strictly controlled to avoid damage. The depth of the puncture needle and optical fiber should be strictly controlled to avoid damage. 3. Postoperative treatment: as above. 4, complications: puncture nerve injury; cartilage endplate injury and bleeding; infection; low back pain and lumbar instability; reflex sympathetic dystrophy; abdominal organ injury. 5, recent and long-term results: laser disc decompression therapy has been reported in the literature, with multiple large sample sizes (292-518 cases) reporting an efficiency of 56-82％. Fourth, the lumbar intervertebral disc spinotomy 1, mechanism: through the direct cutting and suction of the nucleus pulposus of the intervertebral disc, so that the nucleus pulposus tissue compressing the outer fibrous ring is reduced or eliminated, the protruding nucleus pulposus tissue and the outer fibrous tissue and the posterior longitudinal ligament out then retracted and returned, thus reducing or relieving the compression of the nerve root and achieving the purpose of treatment. 2. Operation method: Take prone or L5S1 to take the affected side in the upward bending knee lateral position. Puncture through the safety triangle with a jacket puncture needle under imaging monitoring. If direct decompression of the herniation is to be performed, the lateral view shows that the puncture needle is located in the line of the posterior edge of the flat vertebral body, and the orthopantomogram is located below the arch root shadow, at the small joint space, but there is a possibility of injury to the dura and nerve roots here. The needle is usually decompressed within the nucleus pulposus, and the puncture needle is placed in the intervertebral space, and the image monitoring orthopantomograph shows that the needle tip is located at the inner edge of the small joint, and the lateral view is located 8-10 mm past the posterior edge of the vertebral body. The needle core is withdrawn after arrival, and the dilator and sleeve are placed, and then the electric rotary needle is placed in the sleeve, and the rotary cut is properly fixed and initiated. The operator fixes the sleeve needle with the left hand and adjusts the rotary cutter with the right hand to cut and aspirate the nucleus pulposus tissue from different depths and directions. The nucleus pulposus is removed until no tissue is removed. The needle is withdrawn under continuous negative pressure. 3.Postoperative treatment: the same as laser decompression surgery. 4.Complications: nerve injury, infection, bleeding, spinal instability, endplate injury, disc rupture, cerebrospinal fluid leakage from dural injury. 5, the near and long-term results: traditional excision and suction has a follow-up of 6 to 50 months reported efficiency of 74 to 87％, but the lack of clinical reports of electric spinotomy. 5, intervertebral disc ozone injection 1, mechanism: oxidation of proteoglycans and nucleus pulposus cells, reduce the volume of the protrusion, to achieve the purpose of dural sac and nerve root decompression; anti-inflammatory and analgesic effects. 2.Indications: There is no unified understanding of the recommendation confirmed by clinical experiments. The relevant experts summarize the basic scope of the proposed treatment, which is mainly integrated as follows: 1) persistent lower back pain or/and radicular pain, ineffective after 2 months of conservative treatment 2) numbness or dullness of sensation in the innervated area, mild muscle atrophy and clear signs of radicular irritation; 3) imaging (CT, MRI, discography) confirmed: a. small to medium-sized disc herniation associated with symptoms; b. surgical (minimally invasive) postoperative recurrent residual discs or/and fibroproliferative scars. Methods: There are more clinical application methods, intra-disc injection or intra-vertebral injection is arbitrary, there is no strict standard for application concentration 27 ~50mcg/m (Mario Muto), the injection dose range is too wide (1.5-20ml) some reported 30ml. 3, operation method: basically the same as collagenase chemolysis. 4, postoperative management: the same as unipolar target radiofrequency thermal coagulation 5, complications: most of the literature reported the procedure without complications, but one literature reported a case of postoperative sepsis in one patient, and in recent years in China, there is a cerebrovascular air embolism, post-injection headache, etc. 6, the near and long-term results: the literature reports a large differential guide, follow-up 3 to 12 months, the effective rate of 3.7 to 63％. Recent effects have also been reported up to 70-90％. There is also great variation in morphological changes in the postoperative intervertebral disc, with some reports up to 80％ with changes, while others report no changes (0％). However, a large number of clinical applications have reported recent radicular symptom relief rates of up to about 70％ with ozone intradiscal injections. The following questions remain to be investigated in the clinical application of ozone injection for disc herniation Should the injection be made in the spinal canal or in the intervertebral disc? What kind of cases are spinal canal or intervertebral disc injections? What is the dosage and concentration of injection and its basis? What is the mechanism of action in relation to morphological changes and long-term efficacy? Is the safety absolute? Conclusion The lumbar spine has many diseases and the disc is often herniated Pre-operative diagnosis, smart choice of treatment Traditional and minimally invasive, and surgery Preparation should be adequate, communication should be rigorous Follow the general rules, application is not blind Operation should be precise, the details of the big picture Intra-operative monitoring, strict prevention of complications Post-operative management, training and rehabilitation Efficacy and safety, comprehensive to assess