Lumbar intervertebral disc herniation (LIDH) is a common and frequent disease in orthopedics, and in Chinese medicine, it belongs to the categories of “lumbar and leg pain” and “paralysis”. Lumbar intervertebral disc herniation, also known as “lumbar intervertebral disc annulus fibrosus rupture”, is due to the lumbar intervertebral disc degenerative lesions and injuries, resulting in internal and external mechanical balance of the spinal column, rupture of the disc annulus fibrosus, so that the nucleus pulposus of the intervertebral disc protrudes from the rupture opening, compression of the nerve root or spinal cord and cause low back pain and a series of neurological compression symptoms of a medical condition. It is one of the common clinical low back and leg pain diseases, which occurs in young adults between the ages of 30-50, and seriously affects the quality of life and work of patients. Patients with acute lumbar and leg pain is very serious, the traditional conservative treatment includes lumbar traction, local massage, physiotherapy acupuncture, etc., but the course of treatment is long, the effect is slow, the risk of open surgery is greater, and the postoperative recovery time is long, the author, through many years of clinical exploration, from May 2004 to August 2009, the use of intra- and extra-vertebral canal joint laxation, combined with minimally invasive traditional Chinese and Western medicine therapy for the treatment of this disease, and received a more satisfactory result. 1.Clinical data (1) General data The 68 patients in this group were hospitalized in our hospital from May 2004 to August 2009, of which 23 were male and 45 were female; their ages ranged from 38 to 81 years old, with an average of 52 years old. All of them had clinical symptoms and signs, and were diagnosed as lumbar disc herniation by CT scan or MRI examination. There were 62 cases of single intervertebral disc herniation and 6 cases of 2 intervertebral disc herniation. 5 in L3/4 segment, 36 in L4/5 segment, and 33 in L5/S1 segment, totaling 74 intervertebral discs. The duration of the disease was 3 months-3 1/2 years, with an average of 11 months. Three months of non-operative treatment was ineffective or ineffective, or symptoms recurred. At the time of admission, they presented with symptoms of acute radiculitis, i.e., low back pain with radiating pain in the lower limbs, numbness and weakness in the lower limbs, limited lumbar movement, and difficulty in walking. The patients were randomly divided into treatment and control groups, with 36 cases in the treatment group and 32 cases in the control group. There was no significant difference between the groups by statistical test. (2) Diagnostic criteria: The diagnostic criteria were formulated with reference to the Guiding Principles for Clinical Research of New Traditional Chinese Medicines (2002) and the Diagnostic Efficacy Criteria for Traditional Chinese Medicine (TCM) Diseases, which were implemented in 1995: (1) History of lumbar trauma, chronic strain injury, or exposure to cold and dampness. Most patients have a history of chronic low back pain before the onset of the disease. (2) It often occurs in young adults. (3) Low back pain radiates to the buttocks and lower limbs, and the pain is aggravated by increased abdominal pressure (e.g. coughing, sneezing). (4) Scoliosis, loss of lumbar physiologic curvature, paravertebral pressure at the lesion site, and radiation to the lower limbs, limitation of lumbar activities. (5) Sensory hypersensitivity or retardation in the innervated areas of the lower limbs, muscle atrophy in the case of a long course of the disease, straight leg raising or strengthening test (+), weakened or absent knee and Achilles tendon reflexes, and weakened dorsal extension of the toes. (6) X-ray examination: scoliosis, loss of lumbar physiological anterior convexity, bony hyperplasia on the adjacent margins.CT and MRI examination can show the location and degree of intervertebral disc herniation. (3) Case inclusion criteria: ① clinical diagnosis is clear, conservative treatment for 3 months ineffective chronic lumbar disc herniation; ② acute and subacute lumbar disc herniation; ③ lateral and extreme lateral type lumbar disc herniation (PLID); ④ combined with mild bony stenosis, but did not appear nerve compression and cauda equina syndrome. (4) Exclusion criteria: (1) Combination of bony spinal stenosis with nerve entrapment and cauda equina syndrome; (2) Severe bilateral lateral fossa stenosis or ipsilateral lateral fossa stenosis; (3) Lumbar disc herniation with spinal cord degeneration or paralysis; (4) History of severe drug allergy; (5) Severe metabolic diseases such as cirrhosis of the liver, active tuberculosis, and severe diabetes mellitus; (6) Patients with significant anxiety about treatment; (7) Patients with severe metabolic diseases such as cirrhosis of the liver, active tuberculosis, and severe diabetes mellitus. (vi) Patients with obvious worries about the treatment. (1) Equipment: The fluoroscopic positioning was performed with a Dutch PHILIPS BV-25C arm X-ray machine; the puncture needle was a 16-gauge, 15-cm-long venous indwelling needle; the collagenase was an injectable collagenase produced by Shanghai Yibang Qiaoyuan Pharmaceutical Technology Co. The needle knife was Hanzhang needle knife produced by Beijing Huaxia Needle Knife Medical Instrument Factory. (2) Treatment steps of the treatment group: Step 1 At the early stage of the patient’s admission, the method of treating the symptom in an urgent manner was adopted, and the extravertebral spinal canal was loosened by applying needle knife loosening, and the site of needle knife loosening was selected in the lumbar pressure and pain points, such as the articular synchondrosis joints, the transverse process, and the sphenoid process, etc., and the buttock pressure and pain points, such as the pyriformis muscle pressure point, and the gluteal epiphyseal nerve pressure point, were peeled off by longitudinal cuts. Step 2 One week after needle-knife laxation, intradiscal laxation, i.e., lumbar intervertebral disc collagenase chemonucleolysis (CCNL), was performed, using extradiscal injection, in the following way: the patient was placed in the prone position, with a pillow on the lower abdomen. Using local anesthesia and supervision, the puncture entry point should be selected at 8-11 cm from the spinous process, at an angle of about 45 ° – 60 ° inward and downward into the intervertebral foramen to reach the protruding intervertebral discs outside the intervertebral foramen to check that there is no resistance to the injection of air, the C-arm to check that the needle is well positioned, and then extracted 2% Lidocaine plus dexamethasone 5 mg to 4 ml, injected into the intervertebral foramen, and then measure the sensation of the two lower limbs and muscle strength 10 minutes later, and the patient’s spinal anesthesia is not delayed. If there was no delayed spinal anesthesia manifestation, it indicated that the needle did not enter the arachnoid space. 1200 U of injectable collagenase was dissolved in 4 ml of saline and slowly injected into the intervertebral foramen. After 10 minutes of observation and no adverse reaction, the puncture needle was withdrawn and the hole was covered with a band-aid. After the operation, the patient can be allowed to walk on the ground with a waist cuff after 6-8 hours of lying in bed in the affected side position. (3) The operation method of the control group is the same as step 2 of the treatment group. (3) Results (1) Efficacy evaluation criteria: According to the modified JOA lower back pain scoring criteria (29-point method). The degree of postoperative pain relief was assessed according to the visual analog pain VAS scale. The Japanese Orthopaedic Association (JOA) 1984 efficacy criteria for lower back pain (29-point method), i.e., a normal total score of 29 points, were as follows: ① 9 points for self-perceived symptoms: a low back pain-3 points, b lower extremity pain with numbness-3 points, c decreased walking ability-3 points; ② 6 points for physical signs: a positive straight-leg raising test-2 points, b sensory disturbances-2 points, c decreased muscular strength-2 points; ③ Daily living ability 14 points: a limitation of turning over-2 points, b limitation of standing-2 points, c inconvenience in washing and brushing-2 points, d limitation of forward bending-2 points, e inability to sit for more than 1 hour-2 points, f inability to hold heavy objects-2 points, g limitation of walking-2 points; ③ bladder function: a normal 0 points, b mild difficulty in urination-3 points, c moderate to severe difficulty in urination-6 points. The degree of pain was expressed by visual analogue scales (VAS). (VAS: 0-10, 0 is no pain, 10 is the most pain) Improvement rate = (postoperative score – preoperative score/29 – preoperative score) × 100% Improvement rate up to 75%-100% is considered as excellent; 50%-74% is considered as good; 25%-49% is considered as acceptable; 0-24% is considered as poor; and excellent+good is considered as good rate. (2) Statistical analysis SPSS 12.0 statistical analysis software was used to analyze the follow-up results. Paired t-test was used to compare the preoperative and postoperative JOA scores and VAS scores for analysis, and P<0.05 was considered as significant difference. (3) Mode of follow-up A follow-up card was established, which included the patient's name, age, address, telephone number, medical history, preoperative symptoms, signs, imaging descriptions and postoperative change records. The methods include follow-up, telephone or letter inquiry. All 68 patients in this group were followed up and 1 case was lost. (4) Results of efficacy assessment The average follow-up of patients in this group was 11.2 months (6 months to 2 years). The preoperative JOA score was assessed 1 day before surgery; the recent efficacy was assessed before discharge (about 2 weeks after surgery); the mid-term efficacy was assessed by following up the patients for 6 months, and the postoperative improvement rate and good rate were calculated. After statistical analysis, it was concluded that: 1) the immediate postoperative improvement rate and good rate were significantly higher in the treatment group than in the control group (P<0.01); 2) there was no statistically significant difference in the JOA scores in the mid-postoperative period between the groups; and 3) there was an improvement in the JOA scores in the mid-postoperative period compared with the immediate postoperative period in the treatment group and the control group (P<0.001). Discussion: The pain of lumbar disc herniation is severe during acute attack, radiating along the sciatic nerve pathway, and the pain can be aggravated by coughing or straining to urinate and defecate, and can be alleviated by bed rest. Western medicine believes that lumbar disc herniation is mostly caused by trauma, flash contusion causing fiber rupture. The nucleus pulposus breaks through the annulus fibrosus and bulges out or protrudes laterally and posteriorly, causing compression of the nerve root and cauda equina. Chinese medicine believes that it is caused by external evils such as wind, cold, dampness and trauma that invade the body, blocking the meridians and channels, and poor qi and blood circulation. Its symptoms are mostly caused by the disease and damage of the lumbar meridians, meridians and collaterals, mostly floating in the foot solar bladder meridian. According to the Treatise on the Origin and Symptoms of Various Diseases? The "waist and leg pain and pain" said: "Kidney qi is insufficient, by the wind of the evil is also. Labor injury is kidney deficiency, the virtual is subjected to wind cold, wind and cold and positive qi fight, so waist and foot pain." It can be seen that trauma and wind, cold and dampness are the external causes of intervertebral disc herniation. Currently, the treatment of lumbar disc herniation can be divided into 3 types: conservative treatment, minimally invasive interventional therapy and surgical treatment. The traditional posterior full or half laminectomy to remove the nucleus pulposus of the intervertebral disc has different degrees of damage to the integrity of the lumbar three-column structure, and has a certain impact on the stability of the lumbar spine. Surgical minimally invasive treatment of lumbar disc herniation solves this problem. Its history dates back to the invention of chemical nucleolysis in 1963. Minimally invasive interventional techniques are becoming increasingly popular in surgical subspecialties, including spine surgery, and are centered on minimizing medically induced injury while achieving the same outcomes as open surgery. Chemolysis is one of the early minimally invasive interventions for the treatment of lumbar disc herniation. Collagenase is an enzyme that mainly dissolves collagen, which can effectively dissolve type I and type II collagen in the nucleus pulposus and annulus fibrosus. When collagenase is injected into the target site of a herniated disc, collagenase has a specific solubilizing effect on the collagen in the disc, and collagen is degraded into peptides and related amino acids, which are eventually neutralized and absorbed by the blood plasma, thus reducing the volume of the disc gradually and alleviating or relieving its impact on the nerves. It reduces or relieves its irritation or compression on the nerve tissues, and plays the role of intravertebral loosening. The basic requirement of its treatment is: "medicine reaches the place of disease, enzyme reaches the substrate". As long as the indications are strictly selected, personalized treatment plan is formulated according to the condition, complications are actively prevented and attention is paid to postoperative treatment and rehabilitation guidance, collagenase chemolysis for lumbar intervertebral disc herniation is safe and effective. At present, collagenase injection methods at home and abroad are divided into two types: intra-disc and extra-disc injection. Intra-disc injection concentrates the liquid and dissolves thoroughly, but the indications are narrow, the postoperative pain is severe, spinal instability often occurs in the late stage, and the postoperative recovery period is long. Therefore, extradiscal injection is mostly used in China. According to the literature, the efficacy of surgical removal and chemical disc dissolution in the treatment of lumbar disc herniation is almost equal. Many patients who have herniated discs removed still have residual pain after surgery, and more and more studies have shown that the compression of the herniated nucleus pulposus is not the only cause of pain. Alterations in the physiology of the spine and biomechanical changes due to changes in the paraspinal tissues (including degeneration), i.e., extravertebral lesions, are important factors leading to lumbar disc herniation. Loss of exogenous stabilization by, for example, the muscular ligaments surrounding the spine, the spine cannot maintain its normal function. Thus, dysfunctional mechanical relationships of the muscles are both the cause of lumbar dysfunction and its pathologic result. Small needle knife is to target the imbalanced mechanical relationship outside the spinal canal, to loosen, peel and cut the specific lesions such as local adhesion scars, to loosen the strained and spastic muscle groups, ligaments and small joints, to restore the mechanical balance of the spine, to release the adhesion and spasm of the lumbar vertebral soft tissues, to alleviate the compression of the nerve root , to dredge the meridians, to move the qi and activate the blood, so as to establish the new dynamic equilibrium. Therefore, this method breaks through the traditional Western orthopedics only focus on the concept of intravertebral decompression and release, and draws on the overall concept of Chinese medicine. Therefore, the author adopts the combined internal and external spinal canal decompression and minimally invasive therapy of Chinese and Western medicine to treat this disease, which can not only regulate the dysfunction of the muscular tissues around the spine and loosen the strained and spastic muscles, but also dissolve and reduce the protruding intervertebral discs, relieve the irritation or compression of the nerve tissues in the vertebral canal, and play the role of internal and external spinal canal decompression and loosening, and the results of the statistical results can be seen that the treatment of this disease is more effective than that of the simple lumbar intervertebral disc collagenase chemical decompression surgery. From the statistical results, it can be seen that the effect is faster than simply using lumbar intervertebral disc collagenase chemolysis. The application of this method in the clinic can significantly shorten the course of treatment, rapid relief of symptoms, and play the role of internal and external balance, symptomatic and fundamental treatment. It is also less traumatic, safer, easier to operate, more acceptable to patients, and easier to be promoted in primary hospitals.