Puncture method: 1. T12-L5 disc puncture method (1) The patient is placed in a prone position, routinely disinfected, and the T12/L1 to L5/S1 discs are counted to identify the suspected discs. Both the suspected disc and its adjacent upper and lower discs should be imaged for more accurate detection of the painful disc. The x-ray bulb is angled on the side to be punctured, increasing in angle as it deviates from the posterior midline until the plane of the ray crosses the anterior aspect of the articular eminence and reaches the parallelogram of the intervertebral space. The angle of the bulb is then adjusted in a cephalocaudal direction to “open” the intervertebral space, ideally with the anterior and posterior edges of the cartilage endplates below the disc in a straight line. The access point is marked with an x-ray-opaque object and a suitable puncture needle is selected. Local anesthesia is performed at the entry point, and a 22G 16-20 cm long puncture needle is selected according to the patient’s body shape. Following the principle of “depth, direction, depth”, under X-ray surveillance, the tip of the puncture needle passes ventrally just above the union of the upper and lower articular processes and points to the entry point. The needle is passed through the entry point to the intradiscal injection point and 1-2 ml of the non-ionic water-soluble contrast agent Omnipaque 240 is injected. Postoperative antibiotics were given to prevent infection. (2) Puncture method of L5/S1 disc: The puncture of L5/S1 disc is more specific. The iliac crest and the large L5 transverse process make puncture very difficult. The coaxial technique is usually chosen. The patient is positioned prone and routinely disinfected. Under anterior-posterior fluoroscopy, a line is drawn along the spinous process alignment at a distance equal to the bilateral pedicle. The x-ray bulb is then reoriented until the direction of the rays is in line with the anterior-posterior border of the cartilage endplates beneath the disc. On the anteroposterior fluoroscopic image, the point of entry of the puncture guide needle is marked with an x-ray-opaque object, which should be located just lateral to the superior and inferior synapses, and on the lateral fluoroscopic image this point should be located on a line through the lower 1/3 of the intervertebral foramen and the center of the intervertebral disc. In lateral fluoroscopy, the guide needle should pass lateral to the intervertebral foramen. When entering the puncture needle, it is important to make sure that the curvature of the puncture needle coincides with the oblique opening of the guide needle so that the needle can be entered in the direction of the guide needle and the curvature of the oblique opening. Once in place, the contrast agent is injected and the relevant records are made. Alternatively, a puncture approach to the medial margin of the small joint can be used. The patient is placed in a prone position, and the L5/S1 gap and the corresponding body projection of the medial margin of the lumbar subtalar joint are identified under X-ray. The needle is then tilted slightly outward by 5-10° and slowly entered, encountering the bone, which is the articular eminence, and slightly reoriented, and the needle is inserted immediately into the bone and directly into the disc under X-ray guidance. Although this puncture method is simple and practical with a high success rate, it has a higher chance of damaging the nerve roots and should be chosen in cases where the CT shows a wide and empty lateral saphenous fossa. The puncture must be done slowly and the operation should be stopped promptly if symptoms of nerve root irritation are encountered.