To observe the efficacy of CT-guided target radiofrequency combined with intrathecal injection of medical ozone in the treatment of cervical disc herniation and the distribution and regression of the injected ozone. Methods: 150 patients with cervical intervertebral disc herniation were investigated for contraindications to radiofrequency ozone therapy, and after radiofrequency thermo-coagulation of the herniated material target under CT-guidance via anterior cervical puncture, 5 ml of ozone at 50ug/ml was injected via radiofrequency needle into the anterior interspace of cervical spinal canal dural sac. Cervical spine CT and three-dimensional reconstruction were performed immediately, 24 hours and 72 hours after injection to observe the ozone distribution and regression, and the efficacy of the treatment was followed up. Results: The clinical efficacy of all patients was evaluated according to the Odoms evaluation criteria at 1, 3 and 6 months after treatment, of which 52 cases were excellent, 68 cases were good, 16 cases were acceptable and 14 cases were poor, with an excellent rate of 80%. Postoperative CT and three-dimensional reconstruction showed that ozone injected into the spinal canal in the anterior epidural space separated the dural sac from the herniated material, and ozone disappeared basically in the epidural cavity after 72 hours. CONCLUSION: CT-guided percutaneous puncture disc target radiofrequency combined with epidural injection of ozone is a safe and effective new method for the treatment of cervical disc herniation, and the time of ozone disappearance is about 72 hours. Cervical disc herniation is caused by the herniated cervical disc compressing the adjacent cervical nerve root, and the degenerated nucleus pulposus releasing inflammatory mediators through the ruptured annulus fibrosus to stimulate the cervical nerve root or sinusoidal nerve, resulting in cervical and shoulder pain, upper extremity radiating pain and numbness, or accompanied by a series of symptoms, such as dizziness, headache, etc. The clinical evidence shows that targeted radiofrequency (RF) treatment is a safe and effective method. The effect of target radiofrequency in the treatment of cervical disc herniation has been clinically confirmed, and there is also a large amount of literature supporting the positive role of ozone in the treatment of cervical disc herniation. 150 cases of cervical disc herniation were treated with CT-guided target radiofrequency combined with ozone injection in our hospital from October 2011 to October 2014, and the observation of the therapeutic efficacy and the distribution and regression of the injected ozone are reported as follows. 1, clinical data 1.1 General data The data of this group were 78 male cases and 72 female cases, aged 38-68 years old , with disease duration ranging from 3 months to 5 years. Among them (1) nerve root type: 66 cases. Neck and shoulder pain radiating to the shoulder and upper limbs, accompanied by numbness of the hands, limited neck movement, nerve root pull test (+), head pressure test (+). (2) Spinal cord type: 6 cases. Neck and shoulder pain with numbness, stiffness or reduced strength of the limbs, individual with sensory impairment. (3) Vertebral artery type: 28 cases. Patients had headache, nausea, numbness of the limbs, and episodes of head-turning symptoms. (4) Sympathetic type: 15 cases. (5)Cervical type: 10 cases. (6) Mixed type: 25 cases. Symptoms were mostly combined with two or three of the above types. Before this treatment, all of them had taken analgesic drugs, traction, physiotherapy and other conservative treatments, which were ineffective. All the patients had cervical spine front and side double oblique x-ray films taken, and cervical spine CT and MRI examinations were performed to determine that all the patients had cervical disc herniation, and the following cases were listed as contraindications to treatment: (1) severe spinal stenosis and calcification of the posterior longitudinal ligament; (2) cervical disc severe herniation; (3) severe hypertension; (4) uncontrolled diabetes mellitus; (5) coagulation insufficiency; (6) the patients had systemic infections or local infections at the proposed puncture site; and (7) the patients had a variety of diseases. (6) Patients with systemic infection or localized infection at the proposed puncture site. 1.2 Instruments and equipment Medical oxygen, ozone generator (Herman, Germany), radiofrequency therapeutic instrument (Baylis), Siemens Joy single-row CT. 1.3 Methods (1) The patient signed an informed consent form before the operation; (2) Based on the preoperative cervical vertebrae front- and side-side tablets and cervical spine MRI tablets to determine the vertebral space where the cervical disc herniation is located; (3) The patient lay on the CT scanning bed, with his shoulders elevated and neck slightly tilted back, with a wide tape to place the cervical disc protrusion on the CT scanning bed. (4)Firstly, the CT localization image was used to confirm the diseased intervertebral space, and then the intervertebral space where the herniation was located was scanned routinely with a layer thickness of 2mm, and the corresponding level that could be used for target RF puncture was selected from the scanning sequences obtained, and the puncture path was designed on the selected puncture level: the herniation was used as the target for puncture to determine the optimal skin point of entry and measure the depth and angle of needle entry; (5) The patient was placed on the CT scanning bed in supine position, with shoulders elevated and the neck slightly tilted back, and the patient’s head was secured to the CT headrest with a wide adhesive tape. (5) Routine disinfection and spreading of towels, local infiltration anesthesia for the selected puncture point, dialing the trachea and carotid artery, and then inserting the needle according to the designed puncture path, and then CT scanning again after the puncture needle enters the intervertebral disc, and adjusting the direction and depth of needle insertion until it reaches the target point accordingly; (6) After confirming that the tip of the needle has successfully arrived at the target point by the CT, the routine high-frequency and low-frequency stimulation test is conducted to reconfirm that the tip of the needle is not in the vicinity of the spinal nerves (50°F). In the vicinity of the spinal nerve (50Hz, 2mA test does not correspond to the spinal nerve innervation area tingling sensation, 2Hz, 3mA test does not correspond to the spinal nerve innervation area muscle throbbing sensation), then 90 ℃ 300s radiofrequency thermal coagulation treatment, closely observe the patient’s response, if the patient does not have any discomfort or only have a warm feeling of the neck and shoulders to continue to complete radiofrequency treatment, once the patient complained about the upper and lower extremities burning numbness, then immediately terminate the radiofrequency Once the patient complains of burning and numbness in the upper and lower limbs, the radiofrequency treatment will be terminated immediately, and the electrical stimulation test will be repeated after adjusting the position of the needle tip until the radiofrequency treatment is completed. After radiofrequency treatment, try to inject saline through the radiofrequency needle, if it can not be injected, then the needle tip will be pushed forward 1~2mm, after breaking through the protruding material or fibrous ring, no blood or liquid will be sucked back, inject 2ml of saline (containing contrast agent iodohydroxylin 0.2ml), and then CT scan again, and observe that the injected contrast agent is distributed as a band in the anterior interspace of the dural sac, and then inject 5ml of ozone with 50ug/ml and then pull out the needle, and apply band-aids on the skin of the puncture point, then CT scan again, and then inject the 5ml of ozone with 50ug/ml. A band-aid was applied to the skin at the puncture point, and the distribution of the injected ozone was observed by CT scanning again. During the treatment, the patients’ vital signs such as blood pressure, heart rate and oxygen saturation were continuously monitored. After the operation, the patients were bedridden for 24 hours, and CT and 3D reconstruction of the cervical spine were performed again at 24 hours and 72 hours, and the cervical spine was immobilized by cervical bracing for one month after discharge from the hospital, and the patients’ therapeutic effects were followed up and evaluated. 2.Results All 150 patients in this group were successfully punctured to the target point and completed radiofrequency treatment under the guidance of CT, and there was no damage to the carotid artery, spinal cord, nerve root, and no intervertebral space infection. All patients were distributed in the anterior interspace of the dural sac after injection of 2 ml of saline containing contrast agent, and no patient was found to have entered the subarachnoid space by mistake. Immediately after the injection of 5 ml of ozone, CT three-dimensional reconstruction showed that the low-density gas shadow was distributed longitudinally along the anterior interspace of the dural sac, up to the C2 vertebral body, and down to the T4 vertebral body (see Fig. 6), and CT three-dimensional reconstruction showed a small amount of remnants of the low-density gas shadow at 24 hours after the operation, and CT three-dimensional reconstruction showed that the low-density gas shadow had basically disappeared at 72 hours after the operation (see Fig. 8). All patients were followed up for 6 months, and according to the clinical diagnosis of the disease, the Odoms clinical efficacy evaluation criteria were used to evaluate the 150 patients, with 52 cases of excellent, 68 cases of good, 16 cases of acceptable, and 14 cases of poor, with an excellent rate of 80%. There were no cases of contrast agent or ozone mistakenly entering the subarachnoid space in the whole group. 3, Discussion Cervical disc herniation is one of the common spinal pain, except for a small portion of severe herniation compression of cervical cord or cervical spinal nerve root requires surgical treatment, the vast majority of mild and moderate herniation can be alleviated by targeted radiofrequency ablation treatment. However, the ablation range of radiofrequency thermocoagulation is relatively limited, and the inactivation of inflammatory factors that have already spread is often not thorough enough. Ozone is a strong oxidizing agent consisting of three oxygen atoms, with a strong oxidizing ability that ranks third after fluorine and persulfate. Ozone given through the intervertebral disc has a direct effect on the proteoglycans that make up the nucleus pulposus of the intervertebral disc, leading to the loss of water molecules and subsequent degradation of the cellular matrix, destroying the proteoglycans in the nucleus pulposus and the cells of the nucleus pulposus, reducing the volume of the intervertebral disc, and thus decreasing the compression on the nerve root. Disc contraction reduces venous stasis caused by compression, improves local microcirculation and increases oxygen supply. Medical ozone also has analgesic and anti-inflammatory effects, and can inactivate the inflammatory factors released after a herniated disc, thus eliminating the inflammatory pain symptoms of a herniated disc. Ozone can also inhibit prostaglandin synthesis, inhibit the release of bradykinin and pain complexes, and can increase the release of antagonists or neutralize pro-inflammatory cellular hormones such as interleukin soluble receptor and play a suppressive pain effect. Cheng Yahua et al. found that cervical epidural injection of ozone and Depo-Prostone effectively relieved pain and other symptoms in patients with cervical spondylosis in a controlled clinical trial. Su Qichao et al. found that multiple injections of ozone into the herniated area through the anterior interspace of the dural sac facilitated full contact between the herniated nucleus pulposus and ozone, thus achieving a more thorough treatment effect. In this group of patients, after target puncture radiofrequency ablation of the herniated cervical intervertebral disc, 5 ml of 50ug/ml ozone was injected into the anterior interspace of the dural sac where the herniated material was located, which not only further ablated the herniated intervertebral disc tissues and inactivated the inflammatory mediators, but also completely separated the anterior edge of the dural sac and the nerve root from the herniated material at the corresponding segments, and formed an isolation buffer cushion between the two, which played a role similar to that of the trigeminal microvascular nerve. Play similar to the trigeminal microvascular decompression treatment of trigeminal neuralgia used in polyester cotton pads of the isolation buffer role, so as to achieve better results than pure radiofrequency or pure ozone injection. However, it has a temperature-dependent half-life and is difficult to be stored, and there is no literature report on how long ozone injected into the anterior space of the dural sac can be retained. Therefore, we carried out follow-up CT scans on our patients to observe its distribution and dissipation in the anterior space of the dural sac. After dynamic CT scanning, it was found that 5 ml of ozone injected into the C5/6 intervertebral space could be widely distributed in the anterior dural bursa space from the upper part of the vertebra to the C2 vertebra and the lower part to the T4 vertebra, which completely isolated the anterior edge of the dural bursa and the nerve root from the posterior longitudinal ligament of the corresponding segments, and effectively cushioned the pressure of the herniated material on the nerves, and it could be dispersed within 72 h. It was suggested that, if ozone was injected to the anterior dural bursa space for several times, at least 72 h between injections, it was recommended that ozone be injected at least 72 h between injections. This also suggests that if we want to inject ozone into the anterior dural sac space more than once, at least 72h interval is appropriate. When any treatment technique is used in the clinic, its safety is often weighed more than its effectiveness as the main index to judge its merits. Medical ozone, as a strong oxidizing agent, can effectively ablate the herniated nucleus pulposus of intervertebral discs and eliminate local inflammatory media to achieve therapeutic effects, but if it accidentally enters the subarachnoid space, it can also bring about catastrophic consequences of damage to the central nervous system. This treatment group has carried out a variety of minimally invasive interventional techniques under CT guidance, and found that the CT-guided puncture operation can be accurate to the millimeter level. Therefore, for safety reasons, this treatment should be operated under CT guidance, and before injecting ozone into the anterior interspace of the dural sac, physiological saline containing contrast agent must be injected, and it is confirmed that the injected liquid will not enter the subarachnoid space by CT scanning, and only then can low concentration ozone be injected prudently. Ozone should only be injected cautiously at low concentrations.