(A) Equipment and materials 1, X-ray imaging equipment: C-arm X-ray machine and CT machine is preferred, can make lumbar spine positive and lateral TV fluoroscopy of high-definition X-ray machine can be used. 2.X-ray machine room: there are sterilization equipment, good ventilation conditions, and a preparation room for preoperative hand washing. 3. Radiofrequency ablation instrument. 4. Materials: 1% lidocaine, 5ml empty needle, 1ml empty needle (for intra-disc injection), lumbar puncture dressing pack. (B) Indications: simple lumbar disc herniation. (C) relative indications 1, lumbar disc herniation, recurrence after surgical treatment; 2, lumbar disc herniation with partial calcification; 3, lumbar disc protrusion diameter is greater than 10mm? 4, lumbar disc herniation after 1 treatment to alleviate the symptoms of lumbar disc protrusion, discretionary treatment for the second time. (D) Contraindications: 1, combined with bony spinal stenosis or hypertrophy of the ligamentum flavum; 2, combined with severe cauda equina symptoms; 3, calcification or ossification of the herniated intervertebral disc; 4, vertebral body slippage of more than Ⅱ degree; 5, bleeding tendency; allergies; 6, psychiatric disorders or patients who are unable to cooperate with the operation; 7, serious organic diseases of the heart, liver, lungs and brain. (E) Selection of radiofrequency ablation method: 1. Simple lumbar disc herniation in the lateral and posterior region, accompanied by radiating sciatica in one side of the lower limb, stereotactic target point ablation is preferred. 2.Bulging or central type herniation with lower back pain or alternating sciatica in both lower limbs, preferred intra-disc ablation. 3.According to the protruding part, choose the puncture route, use the medial edge of the small joints to puncture, or use the intervertebral foramen for safe triangular puncture into the needle. (4) If the diameter of the protrusion is larger than 10mm and the effect of ablation is not satisfactory, repeat treatment and ozone can be used as appropriate. (F) radiofrequency ablation operation methods and steps 1, preoperative preparation ① carefully read the film to determine the protrusion width, height and length of the protrusion, to determine the location of the target point, to develop a puncture treatment plan (puncture route and the depth of the needle). ② Introduce the treatment method to the patient, eliminate preoperative tension, and give appropriate amount of sedative and analgesic before surgery. 2.Radiofrequency ablation of the medial border of the small joints: ① Positioning, local skin disinfection: the patient is lying on the fluoroscopic examination bed, the corresponding intervertebral space of the midline of the paracentral opening of 0-2cm, with gentian violet as a puncture point marking. To puncture point as the center of skin disinfection, laying disinfection towel. Local anesthesia: use 1% lidocaine to do local anesthesia layer by layer from the puncture point, and the nerve root should not be anesthetized. Puncture: locate the puncture point through the skin, use the radiofrequency puncture needle, enter the needle vertically or at an angle, through the skin, subcutaneously, through the ligamentum flavum, the spinal canal, enter the needle between the ligamentum flavum and the dural sac, and puncture the target point of the corresponding protruding object. Avoid puncturing the dural sac as much as possible. The tip of the needle is located at the medial edge of the pedicle within the intervertebral disc. Lateral fluoroscopy needle tip is located in the intervertebral herniation, so that the front end of the puncture needle adiabatic varnish is located exactly at the posterior edge of the herniation. It can also be calculated by the formula: A=B-0.5CM where A is the distance between the tip of the needle and the posterior margin of the upper and lower vertebrae, B is the distance between the herniation and the line connecting the posterior margins of the upper and lower vertebrae, and 0.5cm is the length of the exposed end of the puncture needle. ⑤ Nerve test: take out the needle core, put in the electrode, and perform sensory-motor test: sensory nerve, 2-4HZ,1.2mA, motor nerve, 50-100HZ,0.8mA. If there is a strong numbness or muscle twitching reaction, the needle tip position can be adjusted. Impedance value test, usually between 150-250. (6) Heating ablation: Sequentially heating 66 ℃, 76 ℃, 86 ℃ each lasts 30S, 90 ℃ or 92 ℃ heating lasts 180S. In the process of warming the original pain area fever, burning sensation that induced the original pain is better, the pain is intense termination of the warming, adjust the position of the tip of the needle, and re-warming. Multiple target points can be repeated several times. (7) the end of treatment, with a band-aid patch at the eye of the needle. ⑧ postoperative position: keep lying position, 12 ~ 24h. 3, intra-disc radiofrequency ablation operation: ① positioning, local skin disinfection: the patient abdominal lying on the examination bed, abdominal cushion a pillow, the corresponding intervertebral space in the middle of the line to the side of the affected side of the paraplegia 6 ~ 10cm, puncture point with gentian violet as a mark. Skin sterilization, laying sterile towels. ② Anesthesia: 1% lidocaine for local anesthesia. ③ puncture: from the skin marking point, the body of the needle and the lumbosacral region was 45?~60? angle, aligned with the corresponding intervertebral space puncture. L5 ~ S1 intervertebral disc puncture, the body of the needle tilted cephalad 20?~25? or so, the tip of the needle piercing the annulus fibrosus with the astringent sensation. ④ Fluoroscopic needle tip position: the tip of the needle reaches the medial margin of the affected side of the calcaneus in the positive position, and the tip of the needle is located in the middle and posterior 1/5 of the intervertebral disc in the lateral position. ⑤ Nerve test: take out the needle core, put in the electrode, and perform sensory-motor test: sensory nerve, 2-4HZ, 1.2mA, motor nerve, 50-100HZ, 0.8mA. If there is a strong numbness or muscle twitching reaction, the position of the needle tip can be adjusted. Impedance value test, generally between 150-250. ⑥ Rising temperature ablation: sequentially warming 66℃, 76℃, 86℃ for 30S, 90℃ or 92℃ heating for 180S. In the process of warming the original pain area fever, burning sensation that induced the original pain is better, the pain is intense termination of the warming, adjust the position of the tip of the needle, and re-warming. Multiple target points can be repeated several times. ⑦ Position: keep lying down position, 12-24h. 5, postoperative treatment ① after the operation back to the ward to maintain the required position rest, observation of body temperature, pulse, respiration, heart rate, any allergic reaction. ② Postoperative patients are required to lie down for 12-24h. ③ Postoperative generally no special treatment, or symptomatic treatment according to the postoperative response. (G) Complications and treatment of radiofrequency ablation is less traumatic and has fewer complications. Common complications are as follows: 1. Postoperative pain reaction ① Degree: the degree of severity varies from person to person, the reaction of intra-disc injection is heavier than the reaction of extra-disc injection, and in the case that the use of analgesic drugs and symptomatic treatment can not alleviate the symptom, it is necessary to perform disc window decompression. ② Regularity: after target injection, the symptoms can often be relieved, but the symptoms worsened 2 to 3 days after the operation, and gradually relieved after 1 week. ③ Time: some patients can reduce the symptoms after the operation, some patients have a worsening of the pain response after the operation, which usually lasts for about 1 week and relieves by itself. Individual patients’ pain reaction can last for about 3 weeks. ④ patients with heavy pain reaction, postoperative oral painkillers, lumbar wet hot compresses, static mannitol, compound danshen injection and other measures to improve microcirculation, nutritional nerves, reduce nerve root edema and other measures to alleviate the symptoms. 2, lower limb numbness: general numbness area in the original pain area, may be related to the thermal effect of nerve damage, more than 3-7 days, disappear on their own. Methylcobalamin, vitamin B1, etc. can be added. 3.Nerve injury: There is no report of nerve root injury, but in the process of puncture, the tip of the needle touches the nerve and pain reflex occurs, at this time, remember not to force puncture, the direction of the needle tip should be adjusted, and then puncture. 4. Vascular injury: There is no report of death caused by vascular injury. The operation may damage small veins, a small amount of bleeding without special treatment, but need to adjust the direction of puncture. 5, dural sac injury, a small number of patients have dizziness and malignant, infusion of symptomatic treatment disappeared, but there is no clear report related to this.