Low back pain is one of the common clinical diseases, and the incidence of low back pain can be as high as 60%-80% or more in the long-term sub-health, incorrect use of waist young adults, especially in the middle-aged and elderly population. Mild low back pain can be relieved by bed rest, physiotherapy and other conservative treatments, but for chronic severe low back pain, especially in cases with clear disc herniation, surgery is often the most effective method. I. Injection therapy Injection therapy is the most simple and effective minimally invasive treatment method, which mainly refers to percutaneous puncture minimally invasive interventional analgesic surgery under the guidance of X-ray, CT, ultrasound or navigation; this method can be used in the early stage of low back pain, low back pain after lumbar surgery, or elderly people who have lost the opportunity of surgery, and can obtain very satisfactory results. The injection sites can be various parts of spinal nerve, small joint, intervertebral foramen, epidural cavity, intervertebral disc or vertebral body, etc. The materials used in injection therapy are no longer limited to local anesthetics, B vitamins and hormones, but also collagenase, ozone, radiofrequency, laser, bone cement, etc., and are often used in combination to obtain better pain relief effect, such as radiofrequency ablation + ozone, etc. Radiofrequency treatment Radiofrequency treatment can be further enhanced on the basis of the satisfactory efficacy of injection treatment to consolidate the efficacy and obtain a more lasting time. Radiofrequency treatment can generally be divided into continuous radiofrequency treatment and pulsed radiofrequency treatment. Continuous radiofrequency is the use of high frequency continuous current in the tip of the radiofrequency needle to produce high temperature effect, and through the radiofrequency instrument to precisely control the temperature high and low and duration, also known as radiofrequency ablation or radiofrequency thermal coagulation. The temperature can generally be as high as 75℃-85℃ to ablate the disc nucleus pulposus tissue or destroy the spinal nerve, and also to perform nucleoplasty or annuloplasty. Pulsed radiofrequency is a new technology developed on the basis of continuous radiofrequency for the treatment of chronic pain, using pulsed radiofrequency current to form a high voltage near the tip of the radiofrequency needle, which exerts a long-lasting analgesic effect through the neuromodulation mechanism. Since the temperature generally does not exceed 42℃, it does not destroy the function of sensory-motor nerves, and postoperative hyperalgesia or motor dysfunction rarely occurs. Most of the methods currently used in China are continuous radiofrequency temperature-controlled thermal coagulation. We have performed radiofrequency ablation of intervertebral discs and medial branches of spinal nerves under imaging guidance in more than 160 cases according to different etiologies and types of low back and leg pain, and the efficiency rate at 6 months after surgery is more than 80%, which has achieved satisfactory results. Third, vertebroplasty Most elderly people have osteoporosis and are prone to lumbar compression fractures due to trauma and strain, which is one of the common causes of back and leg pain in the elderly. For these patients, percutaneous vertebroplasty is a good minimally invasive surgical treatment option. Percutaneous vertebroplasty is the percutaneous puncture of the vertebral arch or direct puncture of the vertebral body to inject bone cement into the vertebral body to increase the strength and stability of the vertebral body, prevent collapse of the vertebral body, and reduce compression of the intervertebral disc. This procedure is performed under real-time fluoroscopic guidance and monitoring under the C-arm, and patients with a clear diagnosis often receive good analgesia and improved quality of life. Endoscopic spine surgery Endoscopic spine surgery is an extremely minimally invasive method introduced into China from abroad in recent years, and is mainly used to address disc herniation and lumbar spinal stenosis. Depending on the specific surgical access, it can be divided into foraminoscopic surgery and discoscopic surgery. Intervertebral foraminoscopic surgery is performed with only a small 0.7 cm opening in the skin, using a small tube that enters the spinal canal through the safety triangle of the intervertebral foramen, directly confronts the herniated disc tissue and removes it. The surgery is performed under local anesthesia, in the prone position, allowing communication with the operator during the surgery, and the patient can be off the floor in 2 hours after the surgery, and can be discharged on the day of surgery or on the second day. The advantages are: maximum protection of the stability of the spine, less bleeding, less trauma, faster recovery, high efficiency, precise efficacy, and fewer complications. Our current follow-up of more than 200 patients after partial surgery, the postoperative pain disappeared or significantly relieved more than 85%, and no serious complications occurred, which is basically consistent with foreign experience and literature reports. V. Nerve electrical stimulation Nerve electrical stimulation is a minimally invasive, non-nerve-damaging, minimally invasive pain relief procedure that is widely used in Europe and the United States. By implanting stimulation electrodes and pulse generators in the body, it modulates the conduction, presentation and formation of pain sensation in the form of electrical stimulation to achieve the effect of pain reduction or elimination. Depending on the site of electrical stimulation, it can be divided into different procedures such as peripheral nerve electrical stimulation, spinal cord electrical stimulation, deep brain electrical stimulation and motor cortex electrical stimulation. Its application is for lumbosacral pain after lumbar spine surgery, complex regional pain syndrome, neuralgia after herpes zoster, pain after peripheral nerve injury, limb ischemic pain, etc. In Europe and the United States, spinal cord electrical stimulation is most used for postoperative pain after lumbar spine surgery, also known as failed back surgery syndrome. In China, on the other hand, the most important indication is neuropathic pain from various causes. The procedure is performed under local anesthesia and can involve either percutaneous puncture for implantation of needle electrodes or minimally invasive surgical incision of the interspinous ligament and the ligamentum flavum for implantation of surgical electrodes in the form of strips, which actually provide better coverage than puncture electrodes, with a wider variety of electrode shapes and contact combinations available, and are also more conducive to secure fixation and placement in place. Most of the procedures are performed in stages, with the first stage implanting stimulation electrodes for in vitro stimulation testing to observe the efficacy, and then the second stage implanting stimulation pulse generators for long-term in vivo stimulation treatment if the results are satisfactory. The stimulation pulse generator needs to be replaced every 5-8 years, but now there are pulse generators that can be recharged by remote sensing in vitro for clinical use, bringing greater convenience to patients. In recent years, we have completed more than a hundred cases of spinal cord electrical stimulation using surgical stimulation electrodes to treat various causes of low back pain in the elderly, with an overall efficiency of more than 80%, especially for post-operative pain in the low back, complex regional pain syndrome and pain after peripheral nerve injury with the most satisfactory results. When the effect of medication is not good, don’t give up easily, try the above-mentioned minimally invasive treatment methods, and maybe we will help you find the most suitable pain relief!