Adopted before the mid-1990s, now basically eliminated Various interventions, such as dissolution, vaporization, destruction, thermal coagulation, etc., have the commonality of blind targeting, uncontrollable scope, and no objective evaluation criteria for the degree of treatment. The residual tissue is not moved out of the body, and needs to be absorbed by the body naturally, with a long postoperative recovery period. Indirect decompression is achieved only by lowering the pressure in the disk, which has a high chance of recurrence, poor long-term efficacy and many medical disputes. Percutaneous cutting and suction The electric cutting and suction device and related cannulae are placed into the intervertebral disc, and the nucleus pulposus around the lumen is electrically extracted. The volume of nucleus pulposus is reduced, the pressure inside the disc is lowered, and the pressure of the herniated part on the nerves is reduced. Indirect decompression. Part of the nucleus pulposus is removed. Invisible Inclusive bulge Part of the diseased tissue can be removed, effective for mild disc herniation. It was popular in the 90’s, but because of the incomplete decompression and the lack of strict grasp of the indications, which may cause disputes, it has been used less often. Percutaneous laser vaporization (PLDD) Holmium laser or various types of semiconductor lasers with different wavelengths are inserted into the center of the intervertebral disc along the puncture needle to vaporize part of the nucleus pulposus. This reduces the size of the nucleus pulposus tissue, decreasing the pressure inside the disc and reducing the pressure on the nerves at the herniated area. Indirect decompression. The vaporized nucleus pulposus is partially expelled through smoke and partially absorbed by the body. Invisible Inclusive bulging Part of the tissue is vaporized, mild disc herniation short-term effective Laser produces high heat, liquefied tissue remains in large quantities, very many medical disputes, basically not accepted. Radiofrequency thermocoagulation and destruction Radiofrequency ablation (IDET) Various types of radiofrequency instrumentation with time-controlled temperature control The annular electrode is guided into the disc through a puncture needle and coils around the inner wall of the annulus fibrosus, causing the annulus fibrosus to thermocoagulatively shrink and destroying some of the nerve endings Destroying the nerve endings and crumpling the annulus fibrosus. Indirectly reduces compression of the herniated area on the nerve root Unvisible Inclusion of bulging and some discogenic pain Effective for some discogenic pain, but results vary greatly due to the unvisible placement of the RF electrodes in the disc. The device is often used in pain medicine to treat trigeminal neuralgia, nerve destruction in soft tissue pain, and is effective in some patients. In contrast, it is not accepted for the treatment of herniated discs. This is because intra-disc ablation, like laser vaporization, results in limited volume reduction and insignificant symptom relief. Radiofrequency targeted thermocoagulation Various types of radiofrequency instruments with time-controlled temperature control and simple neurophysiological test function are attached The needle-shaped radiofrequency electrodes are introduced into the target area along the puncture needles (either within the intervertebral discs or the herniated parts), and the radiofrequency heat energy makes the tissues thermocoagulable and denatured, water loss, and volume shrinkage, thus alleviating the pressure of the herniated parts on the nerves Indirect decompression. Indirect decompression. The denatured tissue is absorbed by the body naturally, and it is not visible. Inclusive bulging and part of the herniation is effective in the short term for some cases with obvious radicular symptoms. 1. Theoretically, it is hoped that the electrodes will act on the herniated part of the pinched nerves directly, but it is difficult to do so because of the invisibility in actual operation. 2. 2. The patients who need treatment are those who are not cured, and most of the protruding nucleus pulposus is adhered to the surrounding tissues. Even if the protruding part is destroyed by the electrode and the volume is reduced, most of the patients can not lift the compression on the nerve, and the symptoms can not be relieved. 3. The herniated material is not directly removed, and the scope and extent are unpredictable. Some patients with short-term symptomatic relief have a high recurrence rate, and the long-term effect is not accepted. 4.The destroyed tissues are slowly absorbed by the human body, and there is prolonged and severe pain after the operation, and there are many medical disputes. Plasma radiofrequency ablation Plasma radiofrequency instrument Plasma ablation electrodes are inserted into the intervertebral discs, and the nucleus pulposus tissues in the perforations and apertures are ablated at multiple angles. The volume of the intervertebral disc is reduced, and the pressure of the herniated area on the nerves is reduced. Indirect decompression, the small amount of ablated and degenerated nucleus pulposus is naturally absorbed by the human body, which is not regarded as an inadmissible bulge. It is effective in short-term for the patients with high pressure in the intervertebral disc. The purchased units basically stopped using Ozone therapy Various types of ozone generators Ozone is injected into the intervertebral disc, and its strong oxidizing effect causes the nucleus pulposus to lose water, degenerate, and gradually shrink. This reduces the size of the nucleus pulposus in the intervertebral disc and reduces the pressure of the herniated area on the nerves. The anti-inflammatory effect of ozone can relieve pain Anti-inflammatory, analgesic The denatured nucleus pulposus is absorbed by the body naturally Invisible Inflammatory symptoms are more serious Inclusive bulging The anti-inflammatory and analgesic effect of ozone is effective in the short term. Oxidized nucleus pulposus inaccurate, severe postoperative pain, very high medical disputes. Adopted by pain or dermatology departments, commonly used to treat inflammatory pain or skin ulcers. No direct decompression for treatment of herniated discs, in most cases combined with collagenase injections. Basically not accepted by orthopedics Herniated intervertebral disc can be divided into: simple inclusion type bulging, fibrous annulus tear type protrusion, prolapse, free, according to the severity, the treatment can be basically summarized into four categories: 1, traditional conservative treatment, including drugs, internal and external application, massage, traction, local closure, nerve block, knife, etc. 2, interventional therapy, collagenase dissolution, percutaneous cut and suction, percutaneous laser disruption, percutaneous radiofrequency thermo-coagulation and destruction, ozone dissolution, plasma radiofrequency ablation, etc. 3. Minimally invasive surgical treatment Posterior discoscopy, laparoscopy-assisted anterior disc removal, intervertebral foramenoscopy, etc. 4. Open surgery Note: Cases of herniated discs in which the treatment method is prone to disputes are mainly centered on the types of bulging and herniation. Interventional therapies (mainly radiofrequency and laser) are limited to these two types of relatively mild lesions, which reduce the size of the nucleus pulposus by various means and alleviate the pressure of the protruding area on the nerves to relieve the symptoms, and the necrotic tissues are absorbed by the human body slowly after the treatment, resulting in a long recovery period and severe pain. In fact, most patients seek medical attention only when they can no longer tolerate the treatment, and usually there is a torn fibrous ring, prolapsed or even free nucleus pulposus, and adhesion with the nerve. Ablation does not relieve the nerve compression at all, not to mention the fact that many patients have a combination of osteophytes and stenosis. Therefore, this treatment concept is not acceptable to surgeons, and only pain physicians or interventionalists will use this uncertain treatment, which can be referred to orthopedics if it is not effective or if it does not work. Category Methods Equipment Principle of surgery Purpose of surgery Visibility Indications Therapeutic effect Clinical status Remarks Minimally invasive Posterior intervertebral discoscopy (MED) The intervertebral disc endoscope and related equipment are placed into the intervertebral disc, and part of the vertebral plate is removed under the direct view of the endoscope, exposing the nerve root, and the protruding nucleus pulposus is removed and directly decompressing the tissue. Removal of all tissue compressing the nerves Surgery under direct endoscopic vision Almost all types of herniated discs, including bony stenosis and hypertrophy of the ligamentum flavum. Extreme lateral type and foraminal stenosis are relative contraindications Surgical access is similar to open surgery, with slightly less destruction of muscle and ligament than open surgery, with precise and stable results A large number of hospitals buy the procedure. Like open surgery, it is through a posterior approach. Inevitably, the muscles and ligaments must be stripped, also need to bite off part of the vertebral plate, these structures play an important role in stabilizing the spine, after the destruction of the spinal stability is affected; at the same time, the posterior approach interferes with the vertebral canal and nerves, the postoperative period will bring about many unpredictable sequelae, such as long-term pain and partial dysfunction, and at the same time, it will also leave scars, resulting in the adhesion of the vertebral canal and the nerves. It will be very difficult to remedy the surgery again. It is not well practiced in most of the hospitals that have purchased the equipment. Fusion and fixation procedures are usually performed directly with an expandable tubing system with percutaneous fixation or spinal distraction system, which does not allow for the use of MED devices. The minimally invasive approach is straightforward and results in complete lesion removal. Complete decompression of the nerve root under direct visualization is an important criterion for the end of the procedure. Intraoperative continuous irrigation can take the pain-causing chemical mediators out of the body, which is minimally invasive, safe, and has a definite long-term efficacy. Laparoscopic-assisted anterior surgery Laparoscopy and anterior endoscope and related instruments Establish a pneumoperitoneum, insert the anterior endoscope through the abdomen, remove the disc tissue, and fusion or fixation of most of the artificial implants Direct decompression. Removal of all intervertebral disc tissue Surgery under direct vision of the scope Cases of severe degeneration, spinal instability, requiring fixation and fusion There is a big academic controversy, and fewer hospitals have carried out the procedure Intervertebral Foramenoscopy (PELD) Intervertebral Foramen Endoscopy and related instruments The working trocar is inserted into the intervertebral foramen, and the protruding nucleus pulposus tissue is removed under direct vision of the scope, and the proliferating bone is removed by special instruments. Direct decompression. Remove all the tissues compressing the nerves Surgery under direct endoscopic vision All types of herniated discs, foraminal stenosis, spinal stenosis and discogenic pain. Local anesthesia surgery, less traumatic, quick recovery, simple postoperative care, outpatient surgery, accurate and stable long-term efficacy 1, the most minimally invasive surgical treatment means, local anesthesia, the purpose of the operation is direct, decompression is complete; it can be extended to the treatment of the bony structure and the implantation of built-in materials. 2, through the intervertebral foraminal approach, rather than the traditional surgery of the posterior approach, can observe the nerve and spinal canal but will not cause interference. There is no need to strip the muscles and ligaments during the operation, and there is no need to bite off the vertebral plate, which does not damage the stability of the spine; after the operation, no scar tissue will be formed to cause neural adhesion, and the after-effects and complications are extremely low. 3, the technology is currently in a period of rapid promotion, more and more medical institutions to adopt. 4.The direction of development is to combine new materials to complete the artificial nucleus pulposus and artificial disc replacement, with percutaneous technology for fusion and internal fixation. 5, the equipment used not only to complete minimally invasive surgery, but also take into account part of the needs of the pain treatment field. For example, the radiofrequency machine used in this system can do “radiofrequency ablation”, i.e. IDET, which is mainly used for the nerve destruction of discogenic pain, in parallel with fibroplasty, and if necessary, it can also do intradiscal nucleus pulposus ablation; there are 1.2mm electrodes for cervical vertebrae ablation and part of the target point ablation.