(a) Conservative treatment is the basic treatment method of LDP. Most patients in LDP can be relieved or cured by conservative therapy, which aims to accelerate the decreasing of inflammatory edema of the herniated part of the lumbar disc and the irritated nerve root, so as to reduce or relieve the irritation and compression of the nerve root. 1. Indications: ① young, first attack or short duration of disease; ② those whose symptoms can be relieved by themselves after rest; ③ those without spinal stenosis on X-ray examination. 2, specific methods: including absolute bed rest, continuous traction, physical therapy, massage, massage, oral anti-inflammatory and analgesic drugs, focal injection therapy, small needle adhesion release, etc., of which the role of focal injection therapy is to reduce the inflammatory response of the nerve root, the efficiency of the herniated type is significantly better than the bulging type. It is believed that the efficacy of surgery within 2 months of onset is significantly better than that of late surgery. (B) minimally invasive interventional techniques 1, disc chemolysis (chemonucleolysis) disc chemolysis is the application of collagenase hydrolysis, resulting in the degradation of the nucleus pulposus or herniated material, through the relief of nerve root irritation and compression to achieve therapeutic purposes. This technique is mainly used for herniated and prolapsed LDP, and a large number of basic and clinical studies have shown that disc chemolysis is an alternative treatment method. (1) Indications: ① chronic LDP with clear clinical diagnosis and ineffective conservative treatment. ② acute and subacute LDP. ③ herniated and prolapsed LDP. ④ LDP with central calcification of the protrusion but no surrounding calcification. ⑤ combined with mild bony spinal stenosis without nerve entrapment and cauda equina syndrome. (2) Contraindications: ① Combined bony spinal stenosis with nerve entrapment and cauda equina syndrome. (2) Severe bilateral stenosis of the lateral saphenous fossa or ipsilateral stenosis of the lesion. (iii) Severe calcification of the protrusion. ④Patients with a history of severe drug allergy with significant apprehension. ⑤Patients with severe metabolic diseases such as cirrhosis, active tuberculosis, and severe diabetes mellitus. (6) Pregnant women and children under 14 years of age. (3) The risk of inadvertent introduction of collagenase into the subarachnoid space and preventive measures: ① Animal experiments showed that collagenase injection into the subarachnoid space of rats led to spinal cord hemorrhage and necrosis, and all rats developed hind limb paralysis. It is suggested that collagenase accidentally injected into the subarachnoid space can cause spinal cord injury. The incidence of delayed spinal anesthesia was 1.22% in rats with anterior epidural space puncture placement in the sacral fissure. The observation time of the dose of local anesthetic test should be extended to 20 minutes during collagenase chemolysis, and collagenase should be injected only after 20 minutes without spinal anesthesia sign, which is called delayed spinal anesthesia test. The promotion of this method by clinical observation of large samples is an effective measure to prevent the inadvertent introduction of collagenase into the subarachnoid space. 2, percutaneouslumbardiscectomy (PLD) The mechanism of PLD is to reduce the disc pressure by removing the disc tissue, thus weakening or eliminating the tension mechanism of nerve root damage. Clinical reports of randomized controlled studies have an excellent rate of less than 70%, with only 10-15% of indications. Patients requiring surgery are suitable for this technique, but the operation is blind and the postoperative recurrence rate is high. The efficacy and reliability are inferior to those of chemical lysis and endoscopic disc removal, and this technique is not used alone. 3, percutaneous laser disc decompression (percutaneouslaserdiscdecompression, PLDD) operation is similar to PLD, which uses laser to generate heat energy to vaporize the disc tissue, dry and dehydrate it, reduce the tension and pressure generated by the nucleus pulposus tissue on the nerve root, and relieve radicular symptoms. 4, endoscopic discectomy (microendoscopicdiscectomy, MED) (1) endoscopy is divided into three types according to the access: ① posterior-lateral transvertebral foramen access discoscopy. (2) Anterior laparoscopy. (3) Posterior discoscopy: i.e. standard interlaminar disc approach. (2) MED is suitable for single-segment paracentral herniation and prolapse, and allows simultaneous decompression of the spinal canal such as lateral fossa enlargement. Due to good monitoring of the imaging system, blindness is avoided, precise positioning, appropriate amount of resection and effective decompression, little trauma, fast recovery, good spinal stability, and high recent excellent rate. 5, percutaneous puncture intradiscal ozone ablation decompression or targeted radiofrequency thermal coagulation ablation operation is similar to PLD, fluoroscopic puncture into the diseased responsible disc, adjust the puncture needle to the location of the lesion, and then be treated ablation. This method is simple, has a wide range of indications, is minimally invasive, is quick to treat, and is less expensive. In particular, the latter is an emerging minimally invasive interventional treatment method with less trauma and wider therapeutic aspects, which is well received by the majority of patients. (C) The choice of surgical method 1. Indications for surgery: LDP diagnosed by symptoms, signs, imaging and neurological localization, no relief after 6-8 weeks of regular conservative treatment, sensory-motor dysfunction, cauda equina syndrome, intolerable pain or recurrent attacks affecting work and life. 2. Contraindications to surgery: patients with serious cardiopulmonary, hepatic and renal diseases, infectious lesions, severe neurasthenia and psychiatric disorders. 3, the choice of surgical methods: (1) open decompression: low back pain with unilateral lower limb pain, accumulating a gap. (2) Hemilaminectomy: those with low back pain with unilateral limb pain, accumulating two interstitial spaces or those with original diagnosis of protrusion of one interstitial space and intraoperative pathological changes in that interstitial space are found to be insufficient to explain preoperative symptoms and need to explore the adjacent interstitial space. (3) Total laminectomy: ① Huge central lumbar disc herniation with symptoms of acute cauda equina injury. (2) For recurrence after nucleus pulposus removal, where conservative treatment is ineffective and a second operation is required. ③For extreme posterolateral type or combined with spinal stenosis. Partial resection of the articular process or resection of the articular process to achieve complete decompression of the spinal canal and nerve root canal can be used as a fundamental guarantee of satisfactory results. (iv) Reconstruction techniques for lumbar spine fusion have raised concerns about the accelerated degeneration of adjacent discs and the formation of pseudoarthrosis in the fused segment, resulting in postoperative recalcitrant back and leg pain. Allogeneic disc transplantation, artificial disc replacement, attempts at artificial nucleus pulposus technology aimed at rebuilding the physiological function of the disc and experimental research on gene therapy for delaying and reversing disc degeneration are new topics in the treatment of disc diseases. 1, allogeneic disc transplantation: At present, it is difficult to be used clinically because of the problems of early degeneration and displacement. Artificial nucleus pulposus prosthesis replacement is suitable for a small number of patients with LDP and discogenic lower back pain with intact annulus fibrosus and intervertebral space height ≥5 mm, and the clinical effect is symptom relief and satisfactory restoration of intervertebral space height. Its shortcomings are prosthesis displacement and postoperative lumbar and leg pain residual, materials and processes to be further studied. 2. Artificial total disc replacement: The indications that can be considered are mainly discogenic pain, post-lumbar discectomy failure syndrome, and LDP in general should be considered as contraindications, because most LDPs have good long-term results by conventional decompression and/or fusion. The choice of indication for any technique is the primary issue, because if there are very few cases with this technique or if there are other simpler, safer, and more effective methods available, then the widespread use of this technique is questionable. Until the material problem is solved, no artificial disc design and technology can replace conventional decompression fusion, and blind clinical application can be too costly for patients. 3, gene therapy: Some people hope that gene therapy strategies to delay or reverse disc degeneration, growth factors and intervertebral disc degeneration, regeneration of the relationship between one of the hot spots, animal testing through transgenic methods to regulate the expression of a certain growth factor to promote the regeneration of the intervertebral disc extracellular matrix has shown initial results, it is believed that in the future there is hope that the application of human, to delay the purpose of disc degeneration. At present, in addition to conventional open surgery, minimally invasive interventional techniques are already an important means of treating LDP, especially for those with severe symptoms, with better results than conservative treatment. Regardless of the treatment, the indications should be strictly controlled. The key to achieving satisfactory results in the treatment of LDP is correct diagnosis and reasonable treatment.