1, Indications and contraindications PLDN indications: 1, clear symptoms and signs of lumbar disc herniation, and consistent with imaging performance; 2, imaging shows a bulging disc, mild or moderate protrusion, intact annulus fibrosus, and a clearance height greater than 50% compared to normal. PLDN contraindications: 1, free disc herniation; 2, ossified spinal stenosis, degenerative lumbar spine slipped; 3, calcified nucleus pulposus prolapse; 4, cauda equina syndrome; 5, pregnant women; 6, the presence of bleeding tendency, heart, liver, kidney and other important organ insufficiency. Indications for PLOI: 1,, there are clear symptoms and signs of lumbar disc herniation, and consistent with the imaging performance; 2, the imaging examination shows a bulging disc, mild or moderate protrusion, and intact fibrous ring. contraindications for PLOI: 1,, free type disc herniation; 2, ossified spinal stenosis, degenerative lumbar spondylolisthesis; 3, the nucleus pulposus prolapsed calcification; 4, cauda equina syndrome; 5. Pregnant women; 6. Those who have bleeding tendency, heart, liver, kidney and other important organ insufficiency. Collagenase indications: clinical manifestations with clear symptoms and signs of lumbar disc herniation, CT/MRI examination confirming the segment of disc herniation with clinical symptoms and signs, CT scan showing fibrous ring rupture, MRI typing selecting type VI [2] as the best indications. Indications for PLDN combined with ozone and collagenase: 1. clear symptoms and signs of lumbar disc herniation consistent with imaging performance; 2. imaging examination showing disc bulging, mild or moderate herniation, partial prolapse and free, and a vertebral space height greater than 50% compared with normal. contraindications for PLDN combined with ozone and collagenase: 1. ossified spinal stenosis, joint synapse coalescence, degenerative Lumbar spondylolisthesis; 2, nucleus pulposus prolapse with obvious calcification; 3, cauda equina syndrome; 4, pregnant women; 5, the presence of bleeding tendency, heart, liver, kidney and other important organ insufficiency. 2. Mechanism of action The main mechanism of action of PLDN: plasma myeloplasty applies plasma ablation technology, combining thermal coagulation and ablation to remove part of the nucleus pulposus to achieve the purpose of reducing the volume of the nucleus pulposus; then the precise thermal wrinkling technology is used to heat up the nucleus pulposus tissue contacted by the blade to about 70°C, which reduces the total volume of the nucleus pulposus and decreases the pressure in the disc to achieve the purpose of decompression therapy [5- 7]. The principle of cold melting and cutting is to apply radiofrequency energy (100 Hz) to saline (Na+), so that Na+ gets enough energy to break the molecular chains (peptide tendons) between tissue cells and form elemental molecules and low molecular gases (O2, H2, CO2, etc.). The main mechanism of ozone action: 1, O3 immediate oxidation, oxidation of proteoglycans in the nucleus pulposus, so that the osmotic pressure of the nucleus pulposus is reduced, water loss, degeneration, necrosis and atrophy, so that the volume of the intervertebral disc is reduced, while reducing the pressure of the intervertebral disc also changes the local blood circulation, increasing oxygen supply and improving symptoms. 2, anti-inflammatory effect, due to the protruding nucleus pulposus and fiber ring compression of nerve roots and the surrounding veins and blood vessels The herniated nucleus pulposus and fibrous ring compress the nerve roots and surrounding veins, lymphatic tissues, causing venous and lymphatic reflux obstruction and neural edema and exudation, releasing antigenic substances such as glycoproteins and β-lipoproteins, causing the body to have an immune response to form sterile inflammation and adhesions. These factors are the important factors of pain after herniated disc, the anti-inflammatory effect of O3 is through antagonizing the release of immune factors to play anti-inflammatory effect. 3, analgesic effect, the main cause of pain caused by herniated disc is the herniated nucleus pulposus into the spinal canal and produce inflammatory substances and enzyme products (such as substance P, phospholipase A2), stimulating the distribution of the disc surface, adjacent ligaments, small joint synapses and lumbar muscles The strong oxidizing effect of O3 can rapidly inactivate the above inflammatory mediators and achieve pain relief. Muto [2] et al. reported the results of 6-month follow-up after single ozone lumbar intradiscal injection, and the excellent rate of the procedure was 75%. The main mechanism of action of collagenase is a new national class I drug “collagenase for injection”, which is an enzyme preparation extracted from the fermentation broth of microorganisms. It can specifically hydrolyze the three-dimensional spiral structure of natural collagen (the main component of human intervertebral disc is collagen tissue) under physiological PH and temperature conditions, so that it can be broken and further decomposed to make the protruding disc tissue smaller or even disappear, and release the pressure on the nerve root without destroying other proteins and tissues, so as to achieve the purpose of relieving pain. The best indications for PLDN are those who are diagnosed with lumbar disc bulge by imaging examination and whose fibrous ring is not completely ruptured, and the clinical application of PLDN. The basic rationale for clinical application of PLDN in the treatment of disc herniation is to reduce the pressure within the disc, to induce the disc to return to normal form by the tension of the annulus fibrosus, and to indirectly relieve the nerve root compression to relieve the symptoms. This is directly related to a series of inflammatory reactions of the herniated disc in the spinal canal and tissue adhesions that prevent the retraction of the annulus fibrosus. In open surgery for lumbar disc herniation, it is often seen that the herniated material has different degrees of adhesions with nerve roots and dural sac. The normal nucleus pulposus is composed of proteoglycans, collagen fiber network and nucleus pulposus cells, and ozone injection can oxidize proteoglycans and nucleus pulposus cells, but it has little effect on collagen fiber network and cannot effectively reduce the pressure and volume of the disc. The strong oxidation effect can immediately ablate the nucleus pulposus and achieve intra-disc decompression, while the epidural injection of collagenase can ablate the herniated nucleus pulposus and play the purpose of direct target treatment. The combination of low-temperature plasma radiofrequency ablation with ozone and collagenase myelolysis is intended to expand the indications for surgery and improve the efficacy of the procedure, which was previously classified as a contraindication to minimally invasive surgery and an absolute indication for open surgery. In our patients, the excellent rate of PLDN, PLOI and collagenase epidural injection combined application was 93.56% after 11.62±2.67 months of follow-up, which was significantly higher than the treatment effect of single method [6,2], making up for the shortcomings of both single applications and expanding the indications of percutaneous puncture minimally invasive technique for lumbar disc herniation. In conclusion, the combined application of PLDN with ozone and collagenase myelolysis plays a complementary role in the treatment mechanism; it can expand the indications and improve the efficacy of surgery in the treatment of lumbar disc herniation by minimally invasive techniques, and therefore is a better method worth promoting and utilizing.