Chongqing Bishan District People’s Hospital Orthopaedic Department He Bin as a patient of you or relatives, you are still worried? If you or your friends need to consult, please pay attention to the WeChat public number “westorthopaedics” “westorthopaedics” click “patient consultation” or Scan the QR code on this page to consult with us. The current thinking and process of treating lumbar disc herniation can be summarized as follows: conservative (bed rest, traction, physiotherapy, massage, closed and other physical therapy, taking drugs) – interventional (ozone ablation, etc.) – intervertebral foramoscopic techniques, etc. –open surgical decompression combined with brace protection – many different forms of internal fixation of intervertebral fusion (PLIF, TLIF, OLIF, DLIF, ENDOLIF) or replacement. Conservative treatment is preferred for patients with lumbar disc herniation if the symptoms are mild. Most patients, in the early stage, can be cured or basically recovered by bed rest, traction, physiotherapy, massage, closure and other non-surgical treatment methods such as physiotherapy and medication. However, traction, heavy manipulation and massage should be used with caution to avoid aggravating the disease and even causing paraplegia. A small number of patients may have secondary lesions such as spinal stenosis and instability due to long nerve compression or severe compression. If conservative treatment is ineffective, or if the symptoms do not improve significantly, the patient should receive surgical treatment. In terms of surgery, there are minimally invasive interventions, minimally invasive foraminoscopy, minimally invasive access (TLIF, OLIF, DLIF, ENDOLIF) and other minimally invasive procedures, and there are open procedures (PLIF, TLIF, etc.), regardless of whether minimally invasive or open, there are mainly the following modalities: 1. Ozone ablation: the thinnest needle under the disc surgery, theoretically the most minimally invasive, with only a needle-eye size mouth and no scars. It is suitable for patients with simple lumbar disc herniation whose symptoms are mild and whose nucleus pulposus is not free, almost non-invasive, with significant effect, and this treatment method does not conflict with other treatment methods. The advantages of ozone treatment for lumbar disc herniation include the following: accurate localization: the lesion is localized under the guidance and monitoring of X-ray fluoroscopy or CT, and the puncture is accurate and reliable. Accurate positioning is very helpful in the treatment of herniated lumbar discs. Immediate effect: after injecting ozone into the disc, the nucleus pulposus is dissolved and the dural sac is restored with CT scan, effectively relieving the compression of the nerve. Good safety: fine needle puncture under local anesthesia, mainly acting on the nucleus pulposus, no damage to other tissues. The treatment of lumbar disc herniation is the safest method. Ozone injection can treat herniated disc because: ① Ozone can directly oxidize the proteoglycan complex in the nucleus pulposus and destroy the double bonds in the amino acids and CH groups in the proteoglycan complex, causing the nucleus pulposus to lose water and decrease in size. Ozone can also damage the nucleus pulposus cells, causing a decrease in proteoglycan synthesis and secretion, and a reduction in the size of the nucleus pulposus. (2) Ozone can stimulate the overexpression of antioxidant enzymes to neutralize the excess reactive oxygen species in the inflammatory response; stimulate the release of cytokines (such as IL-l, IL-2, IL-8, etc.) and/or immunosuppressive cytokines (such as IL-10, TGF-β1) involved in the inflammatory response in vivo; stimulate the release of NO and PDGF from vascular endothelial cells to cause vasodilation, thus promoting inflammation absorption It also inhibits the synthesis of prostaglandins and the release of bradykinin and pain complexes. The analgesic mechanism of ozone treatment for lumbar disc herniation also includes the inhibition of unmyelinated receptor fibers, activation of the body’s anti-injury system, and the release of enkephalins through the stimulation of inhibitory interneurons, similar to the mechanism of “chemical acupuncture”. Compared with other minimally invasive treatment methods for lumbar disc herniation, ozone intradiscal injection has its unique advantages. 2. Percutaneous foraminoscopic technique of nucleus pulposus removal: It is suitable for the treatment of almost all types of disc herniation, spinal stenosis, foraminal stenosis, ligamentum flavum hypertrophy, tuberculosis, calcification and other bony lesions, and for the revision of patients with recurrence of previous open and discoscopic surgery. Special radiofrequency electrodes are used under the scope to treat discogenic pain with feasible fibrous annuloplasty and nerve branch block. Indications will be strictly controlled due to the learning curve of the new technique. The emergence of discoscopy in the mid-1990s popularized the concept of minimally invasive spine, and professors such as HOOGLANG,WOLGAN in Germany invented the modern intervertebral foramoscopic technique – lateral access and distal lateral access technique, which expanded the observation and operation field in the spinal canal by molding the intervertebral foramen and invented the corresponding set of equipment. The JOIMAX company was established, and intervertebral foraminoscopy technology began to spread rapidly throughout the world. The target area is reached through a lateral approach, avoiding interference with the spinal canal and nerves from traditional posterior surgery, without biting off the lamina, without destroying the paravertebral muscles and ligaments, and with no effect on spinal stability. This is incomparable to traditional open surgery and discoscopic surgery. Direct purpose The surgical effect is clear, no recurrence rate and no complications. High safety Local anesthesia, intraoperative interaction with the patient, no injury to nerves and blood vessels; basically no bleeding, clear surgical field of vision, greatly reducing the risk of misuse; fast recovery The next day after surgery, you can be discharged from the hospital and resume normal work and physical exercise in an average of 3-6 weeks. 3. Minimally invasive access or open intervertebral implant fusion internal fixation (PLIF, TLIF, OLIF, DLIF, ENDOLIF): for patients with various types of lumbar disc herniation with heavy symptoms and free nucleus pulposus, or with significant lumbar pain with intervertebral instability, and can resolve mild lumbar spinal stenosis. The trauma is relatively large and the postoperative effect is good. Due to the development of biomaterials and imaging, an interventional therapy has emerged between conservative and open surgery, in which a needle is punctured into the disc and ozone and other substances are injected, which can significantly improve pain. For patients with poor conservative interventions and significant radicular symptoms, the foraminoscopic technique, which is currently considered the “gold standard” for the treatment of lumbar disc herniation, can be considered. Finally, fusion techniques, which sacrifice spinal motion to pursue spinal stability, or disc replacement, which is in the clinical research phase, can be considered.