Percutaneous discotomy 1, treatment principle: through the disc fiber ring small window, and remove part of the nucleus pulposus weave, so that the internal pressure of the disc to reduce the nerve roots and nociceptive receptors around the disc to relieve stimulation, so as to achieve intra-disc decompression to eliminate symptoms for the purpose. The mechanism of action has three aspects: ① reduce the contents of the intervertebral disc; ② reduce the pressure within the disc; ③ change the direction of the protrusion of the intervertebral disc. 2.Puncture route: safe triangular approach intradiscal puncture 3.Indications: Suitable for bulging type or contained protrusion type. The prolapsed type and free type are not suitable. 4.Technical advantages: Compared with open surgery, it has the advantages of less trauma, faster recovery, no interference with the internal structure of the spinal canal, and simple operation. Percutaneous disc plasma ablation 1, treatment principle: is the use of low-temperature current ablation of the herniated nucleus pulposus to achieve the decompression effect of the disc, while the effect of thermal coagulation to make the disc degeneration retraction to release the compression of a treatment method, so the plasma ablation includes two: low-temperature ablation and thermal coagulation. In view of its two therapeutic effects, foreign scholars also call it radiofrequency ablation myeloplasty. Its theory is based on the fact that a small change in volume can produce a large change in pressure. It uses 40°C low-temperature thermal coagulation energy to cut multiple tunnels in the nucleus pulposus, together with 70°C thermal coagulation to fluidize, contract and solidify the collagen fibers, remove part of the nucleus pulposus tissue (about 1 cubic centimeter), reduce the pressure of the herniated disc, relieve the compression on the nerve root, and eliminate symptoms such as pain and numbness. 2.Puncture route: Posterior lateral safe triangular approach for intradiscal puncture. 3.Indications: bulging type or contained protrusion type can be used; prolapsed type and free type are not suitable. 4, technical advantages: there is a more certain decompression effect. It is suitable for the treatment of bulging disc herniation with high intra-disc pressure; because the plasma ablation produces only a pore of less than 2mm in diameter in the nucleus pulposus, the spiral structure of collagen around the pore is crinkled, but the cells still remain active, so it is more suitable for herniation with narrower intervertebral space. Percutaneous laser vaporization of the intervertebral disc 1. Treatment principle: Percutaneous laser decompression of the intervertebral disc is a minimally invasive interventional technique that is performed under local anesthesia by piercing a needle through the skin into the intervertebral disc and then introducing a light-guided fiber to reduce the pressure in the intervertebral disc or target point laser vaporization through strong laser cutting vaporization, coagulation, and action to release the nerve root compression. 2.Puncture route: (1) posterior lateral safety triangle access intradiscal puncture (2) lateral saphenous fossa intra-articular rim intradiscal puncture (3) small intra-articular rim target puncture. 3. Indications: (1) Patients with discogenic lumbago, lumbar disc herniation, lumbar spinal stenosis with low back pain or symptoms such as pain, numbness or intermittent claudication in the lower extremities, which have been ineffective after three months of regular conservative treatment. (2) CT or MRI showing degeneration, bulging, protrusion or prolapse of the disc without freeing. (3) Clinical manifestations are consistent with imaging, or have corresponding localization signs. 4, technical advantages: the high energy released by the laser can cause a variety of biological effects on the tissue; it has a destructive effect in the center of the tissue and a good thermal effect around the tissue, and this deep thermal effect is better than other minimally invasive techniques when applied to treat sympathetic cervical spondylosis and lumbar disc herniation with cold lower limbs Collagenase lysis 1, treatment principle: the main component of the intervertebral disc is collagen, collagenase can selectively Collagenase can selectively dissolve the collagen fibers in the nucleus pulposus and fibrous ring and degrade them into amino acids such as proline, hydroxamic acid and lysine. Then through blood circulation and lymphatic circulation and absorption, so that the protrusion can be reduced or disappeared and the compression on the spinal cord or nerve root can be relieved to achieve the purpose of intra-disc decompression, extra-disc dissolution and target point dissolution. 2. Indications: (1) Lumbar disc herniation with clinical symptoms and signs consistent with imaging. (2)The disc herniation whose symptoms are heavy and the regular conservative treatment is ineffective. (3) Patients can correctly understand disc dissolution and urgently request for disc dissolution. 3.Technical advantages: (1)Small trauma (2)Accurate puncture can make collagenase concentrate on the lesion (3)Intradiscal or extradiscal injection can be chosen according to the condition (5)Accurate positioning mark (6)Safe and reliable 4.Technical requirements of collagenase lysis Only when collagenase is injected into or around the herniation, the collagenase solution has enough concentration to combine with the herniation to achieve the purpose of dissolving it. (1) The puncture needle must be accurately placed, i.e., it must penetrate into the disc or outside the herniated disc (the puncture needle is close to the herniation) (2) The collagenase concentration must be locally saturated to effectively dissolve the herniation. (3) Collagenase, as a protein, can only be active at the appropriate pH and temperature. Loss of these two basic conditions. The enzyme activity will be mostly or completely lost. 5.Problems of collagenase lysis (1)Some only pay attention to injecting collagenase into the anterior epidural space without emphasizing the contact between collagenase and protrusions; (2)Some puncture from the posterior side and inject collagenase into the posterior epidural space, wanting to let collagenase pass through the fat and blood vessels between the vertebral canal and the dural sac, loosening the connective tissue relying on gradient diffusion, so that collagenase can combine with protrusions. (3) Some do not even confirm the puncture location by means of imaging surveillance, and inject collagenase based on feel and vacuum test or anesthesia test alone. This makes it difficult to ensure that collagenase aggregates locally in or around the protrusion, or reaches sufficient concentration. 6, collagenase lysis operation method and injection site Collagenase can be injected inside the disc, outside the disc or combined inside and outside the disc, and any other way that can be injected into the disc herniation site to treat the disc herniation, but only according to the patient’s clinical symptoms and different parts of the disc herniation to choose the injection treatment method, in order to obtain good treatment results. The following is a description of the various injection methods. Ozone oxidation nucleus ablation 1, treatment principle: ozone has a strong oxidizing effect, injected into the intervertebral disc can quickly oxidize the proteoglycan in the nucleus pulposus, the nucleus pulposus cell membrane and intracellular structure destruction, cell synthesis function decreased, the nucleus pulposus osmotic pressure decreased, resulting in water loss, the nucleus pulposus dry atrophy, volume reduction, the intravertebral disc pressure decreased. This reduces the compression on the peripheral nerves and achieves the purpose of intradiscal decompression therapy. 2.Puncture route: (1) posterior lateral safety triangle approach (2) lateral saphenous puncture approach 3.Indications: Applicable to bulging type or contained protrusion type. Prolapsed type and free type are not suitable. 4, technical advantages: (1) fast decompression, rapid action, especially for central bulge, foramen ovale (2) unique anti-inflammatory effect, suitable for diabetic patients (3) few side effects, so far no serious adverse reactions and complications have been reported. Radiofrequency ablation 1, treatment principle: through the radiofrequency vaporization rod, the radiofrequency current through the destruction electrode to reach the nucleus pulposus tissue, causing ion oscillation heat generation, thermal energy to interrupt the organic molecular bonds of the nucleus pulposus, so that the collagen molecules in the nucleus pulposus contract, the nucleus pulposus tissue is vaporized and atrophied, the volume is reduced, the internal pressure of the intervertebral disc is reduced, thus reducing the pressure on the peripheral nerves, to achieve the intra-disc decompression, target ablation treatment purpose. 2.Puncture route: (1) posterior lateral safe triangle access intradiscal puncture (2) lateral saphenous fossa intra-articular margin intradiscal puncture (3) herniated target point puncture 3.Indications: bulging, herniated and prolapsed types are available 4.Technical advantages: The advantage of continuous radiofrequency thermal coagulation ablation is that the scope of destruction is limited, the degree of destruction can be controlled, and it can be used for target point ablation treatment of herniated nucleus pulposus, which can immediately release the herniated The nerve root compression by the herniated material can be immediately relieved, while the height of the intervertebral space and the physiological role of the disc are maximally protected. Percutaneous discotomy 1. Treatment principle: 17G spoon drill is used to remove the nucleus pulposus tissue to reduce the pressure within the disc and around the nerve root, and it can also directly target the nucleus pulposus tissue to treat lumbar disc herniation. The device consists of an electric handle with batteries, a special rotary drill (probe), a special scraper, etc. In 2006, our hospital started to engage in this area, and the effect of treating many patients was observed, with small trauma, high accuracy, high controllability (the amount of puncture operation and rotary cutting ), treatment intuitive (can quantitatively and selectively rotate and remove the prominent nucleus pulposus tissue at that time). It can completely release the compression on the spinal nerve or nerve root to achieve the purpose of cure. 2.Puncture route: (1) posterior lateral safe triangle access intradiscal puncture (2) lateral saphenous fossa small joint inner edge intradiscal puncture (3) small joint inner edge target puncture 3.Indications: (1) clinical symptoms, signs and imaging examination (including X-ray, MRI, CT, discography) results consistent with lumbar disc herniation, bulging type, herniated type, prolapsed type can be. (2) Those who do not have good results by conservative treatment (such as drug therapy, physical therapy or epidural cavity injection therapy, etc.). Clamping (YESS technique) Treatment principle: A minimally invasive procedure to treat cervical and lumbar disc herniation by clamping a certain amount of nucleus pulposus tissue to reduce the pressure within the disc and around the nerve roots to induce the herniated disc to retract, thereby relieving or eliminating the compression and irritation on the spinal nerve roots or the dural sac. Perforation route: safe triangular entry into the disc Indications: for bulging discs without narrowing of the intervertebral space Technical advantages: direct decompression, significant effect, high safety Intervertebral foramoscopy spinal ultra-minimally invasive surgery (THESSYS technology) Treatment principle: it is a spinal system composed of a specially designed intervertebral foramoscope and corresponding supporting spinal minimally invasive technology instruments, imaging and image processing system, and dual-frequency radiofrequency machine. minimally invasive surgical system. Positioned under DSA, it enters the intervertebral foramen from the lateral or posterior side of the patient’s body. The procedure is performed in the safety triangle. The surgery is performed outside the disc’s fibrous annulus, and the herniated nucleus pulposus, nerve roots, dural sac and hyperplastic bone tissue can be clearly seen under direct endoscopic vision. Then various types of grasping forceps are used to remove the herniated tissue, remove the hyperplastic bone, thicken the ligamentum flavum, and bipolar radiofrequency electrodes repair the broken annulus fibrosus to prevent re-protrusion and completely release the pressure on the nerve root. Puncture route: safe triangular approach into the intervertebral foramen outside the fibrous annulus of the anterior space of the dural sac. Indications: It is suitable for all kinds of lumbar disc herniation, especially moderate and severe disc herniation. Technical advantages: minimally invasive visualization, wide range of indications, and high safety.