What is a herniated disc? Intervertebral disc herniation, which most often occurs in the lumbar and cervical spine, is the most common cause of low back and leg pain and neck and shoulder pain in daily life and is the main cause of neck, back and leg pain in young and middle-aged people. The etiology of this disease is complex, but mainly includes two aspects: external and internal causes. Common exogenous causes include rupture of the intervertebral disc fibrous ring injury caused by various acute and chronic injuries (such as sprains, strenuous exercise, long-term weight bearing, etc.), smoking, diabetes, etc. Endogenous causes mainly include genetics, spinal instability, age, gender, etc. The pathogenesis of the disease is the degenerative changes in the various parts of the disc (nucleus pulposus, annulus fibrosus, cartilage plate) due to the combination of external and internal factors, resulting in the rupture of the annulus fibrosus and the protrusion of the nucleus pulposus, which causes a series of clinical symptoms by compressing the adjacent spinal nerve roots, spinal cord, blood vessels, etc. The typical clinical manifestation of lumbar disc herniation is lumbago with radiating pain in the lower extremities, which can occur unilaterally or on both sides, and weakness of the lower extremities and urinary and fecal disorders can occur when the compression is severe. The main clinical manifestation of cervical disc herniation is pain in the neck and back of shoulder, which may be accompanied by numbness of upper limbs. If the compression of spinal cord is obvious, it may be accompanied by symptoms such as weakness of limbs and unstable walking, and compression of vertebral artery and its surrounding sympathetic nerve may produce symptoms such as headache, vertigo, palpitation and chest tightness. What are the treatment methods for cervical and lumbar disc herniation? The three main treatment methods are conservative treatment, interventional treatment and surgical treatment. Conservative treatment (also called non-surgical treatment): including rest in a hard bed, reduction of activities during the acute period, massage, traction, physical therapy, etc., and the use of anti-inflammatory and pain-relieving drugs. Interventional minimally invasive treatment: percutaneous ozone nucleus pulposus oxidation, percutaneous nucleus pulposus collagenase lysis, percutaneous laser disc pneumatization, percutaneous radiofrequency targeted ablation, percutaneous puncture disc excision and aspiration, percutaneous intravertebral disc electrothermal therapy. Surgical treatment: disc removal, vertebral body fusion, and decompression of the vertebral plate. Comprehensive interventional minimally invasive treatment for disc herniation Comprehensive interventional minimally invasive treatment for disc herniation is to individually select the safest and most effective interventional minimally invasive treatment technique according to the location and number of diseased discs as well as the site, degree, scope and type of nucleus pulposus protrusion, or to combine two or more techniques, and to integrate drugs, physical therapy, rehabilitation and other means to achieve the cure of disc herniation. The purpose of minimally invasive treatment is to cure disc herniation. The characteristics of comprehensive interventional minimally invasive treatment are individualization, core effectiveness, and advantages of safety. Percutaneous ozone nucleus pulposus oxidation Percutaneous intradiscal ozone injection is currently recognized as one of the least invasive and safest minimally invasive treatment techniques for intervertebral disc lesions. A very fine needle (about 0.6 to 0.8 mm) is punctured through the back into the diseased disc, and ozone is then injected into the disc and around the herniated disc. Using the strong oxidizing properties of ozone, the proteoglycan, the main component of the nucleus pulposus, is oxidized, causing the nucleus pulposus to decrease in osmotic pressure, lose water and atrophy, resulting in a reduction in the compression of the nerve roots and dural sac by the nucleus pulposus. At the same time, ozone has a strong anti-inflammatory and paroxysmal effect, which can significantly reduce the sterile inflammation around the nerve caused by the herniated disc. This technique has the following advantages: 1. high safety factor, the use of 20-22G fine needle (0.6~0.8mm) puncture under local anesthesia, mainly on the nucleus pulposus tissue, no effect on other tissues 2. no anesthesia, less pain, significantly more effective than conservative treatment, while avoiding the pain of open surgery 3. precise positioning, the operation under imaging guidance, so that the ozone can accurately reach the desired site 4. 4. Rapid onset of action, long-lasting effect and few postoperative complications. Percutaneous nucleus pulposus collagenase lysis Percutaneous nucleus pulposus collagenase lysis uses the property of collagenase to specifically dissolve the collagen in the herniated disc, and uses fine needle puncture to inject collagenase into the site of the herniated disc, so that the herniated material gradually dissolves, absorbs, shrinks or disappears, thus relieving the pressure on the nerve root and achieving the purpose of cure. This method can directly decompose the nucleus pulposus tissue to achieve direct decompression, and can be used as a complementary means when ozone treatment is not good. Clinical studies have reported that the total clinical efficiency of combined ozone and collagenase treatment for herniated discs can reach more than 90%. Percutaneous disc laser vaporization: Laser vaporization for disc herniation is another new interventional minimally invasive technique. The diseased disc is punctured by a fine needle of about 1 mm, and then optical fibers are introduced along the needle. Using the vaporization effect of the laser, the nucleus pulposus tissue of the diseased disc is dehydrated and coagulated and atrophied, so that the internal pressure of the disc is reduced and the protruding disc is partially retracted to relieve the nerve compression as an interventional technique. The advantage of this method is that it can be performed under local anesthesia, which is less invasive, safer, shorter hospital stay, no scarring, and more effective. Percutaneous radiofrequency target ablation: Under the real-time guidance of imaging equipment, radiofrequency electrodes are precisely guided to the herniated part of the intervertebral disc for thermal coagulation and ablation to denature and coagulate the nucleus pulposus and reduce its size, thus relieving or alleviating the compression on the nerve root and nucleus pulposus. Percutaneous radiofrequency targeted ablation reduces nerve root compression while repairing the rupture of the annulus fibrosus, inactivating the nerve endings in the disc that are hypersensitive to new lesions, directly blocking the release of glycoproteins and β-proteins in the nucleus pulposus, and reducing the aseptic inflammatory response around the nerve roots and dural sac, which often rapidly reduces or disappears after treatment. The advantages of this method are low trauma, high safety, definite decompression effect, and fast onset of action. Intradiscal intradiscal electrothermal therapy (IDET): Intradiscal intradiscal electrothermal therapy (IDET) is a new method used abroad in recent years to treat discogenic lower back pain, also known as intradiscal electrothermal fibrous annuloplasty. The mechanism of IDET for discogenic low back pain: (1) local heat therapy causes the collagen fibers in the fissures to contract and remodel to heal the tears; (2) heat inactivates the tissues of the intervertebral disc; (2) Heat inactivates inflammatory factors and degrades collagen in the disc, thus eliminating chemical pain-causing factors; (3) Heat inactivates the nociceptive nerve endings distributed in the outer layer of fibers (sinus nerve) and loses the ability to receive and transmit pain signals; (4) Deep heat therapy improves microcirculation in the spinal canal; Percutaneous percutaneous discectomy and aspiration: Percutaneous discectomy and aspiration was the first minimally invasive technique widely used in patients with disc herniated disc. It uses a special puncture system under imaging guidance to create a channel between the skin and the disc of about 3 mm in diameter, and a rotary cutter or nucleus pulposus is used to partially remove the nucleus pulposus, thereby reducing the compression of the nerve root by the nucleus pulposus. The safety and effectiveness of percutaneous discectomy and aspiration have been clinically proven, but it is more invasive than the above-mentioned minimally invasive techniques, so it is currently used as an important complementary method to comprehensive interventional treatment of herniated discs, but not as the preferred method.