【Abstract】：Objective: To observe the clinical effect of percutaneous transluminal waterjet nucleotomy and aspiration in the treatment of cervical disc herniation. Methods: Retrospective analysis of 46 patients who were hospitalized for percutaneous transluminal waterjet nucleotomy and aspiration for cervical disc herniation in our hospital from Feb. 2009 to Feb. 2010. Results: Evaluation by modified MacNab method, postoperative follow-up 3 months -12 months, treatment excellence rate 91.3%, none of the cases had serious complications. -Conclusion: percutaneous waterjet nucleotomy and aspiration for cervical disc herniation is safe, minimally invasive, and has excellent clinical efficacy. Keywords: waterjet, cervical disc herniation, 1, clinical information 1.1, general information, case inclusion criteria: neck, shoulder and upper extremity pain, numbness, muscle weakness and other symptoms, after 3 months of conservative treatment is ineffective, CT, MRI and other impact of the diagnosis of a clear, non-protrusive free-type disc herniation, and clinical symptoms and signs consistent with the person. Case exclusion criteria: CT shows that the protruding disc has been calcified or ossified, intervertebral foramen, intervertebral joints and hooked vertebral joints osteophytes, disc degeneration leading to intervertebral space narrowing puncture difficulties, yellow ligament hypertrophy cervical spinal canal stenosis. 1.2 Imaging manifestations: 70 intervertebral spaces in 46 patients (24 cases of single space, 20 cases of double space, 2 cases of 3 spaces), 20 cases of male, 26 cases of female, age 35-66 years old, history of disease 3 months-12 months, all cases were determined to be the main cause of clinical symptoms by X-ray film, CT and MRI examination of protruding discs, and the lesion was the main cause of clinical symptoms. All cases were determined by X-ray, CT and MRI that the herniated disc was the main cause of clinical symptoms, and the distribution of the lesion space was C3.4 8 space, C4.5 32 space, C5.6 26 space, C6.7 4 space. 1.3 Surgical methods: Surgical equipment produced by the United States company spinal disc waterjet; (2) C-arm X-ray machine; (3) multi-parameter electrocardiographic monitor. Operation method: the patient supine position, neck cushion pillow so that the head is slightly tilted back, in the C-arm X-ray machine to determine the puncture gap under the supervision of routine skin disinfection and laying sterile towel, the entry point of the midline next to the open 2-3cm, the operator’s left thumb in the horizontal line of the internal edge of the sternocleidomastoid muscle touched the carotid artery, will be pushed to the outside of the 1-1.5cm, the thumb tip of the finger downward pressure until it touches the anterior edge of the vertebral body, so that the carotid artery is located in the thumb on the palmar side, the dorsal edge of the thumb nail in the middle, and the thumb nail in the lateral margin of the palm. After local anesthesia, a 16G*10cm puncture needle was inserted into the intervertebral disc one by one under the supervision of a C-arm X-ray machine, the puncture trocar was fixed, the core of the needle was withdrawn and a guide wire was inserted, the puncture needle was withdrawn, and a skin incision was made with the guide wire as the center of the disc for about 0.5cm, and a two-level and three-level trocars were inserted along the guide wire, and the tip of the three-level trocars were determined to be silent by the front and side fluoroscopic view of the C-arm X-ray machine. The middle and posterior 1/3 of the intervertebral disc junction, waterjet head into the casing, progressive backward push, pull, rotate, cut suction nucleus pulposus tissue, when the waterjet head in the intervertebral disc there is a clear sense of looseness, suggesting that the nucleus pulposus tissue decompensated, decompression, decompression, surgical purposes have been achieved, cut suction time is generally 2min, at this time the patient will complain of preoperative pain in the neck and shoulder region and upper limbs to ease the pain, cut suction treatment is over, cut the incision of the self-adhesive The incision is self-adhesive, and the dressing is pasted on. Postoperative routine application of dehydration drugs and antibiotics for 3 days, bed rest for 6 hours, after 24 hours can get out of bed activities, need to wear a cervical collar activities within 1 month. 1.4 Postoperative efficacy evaluation Refer to the modified Macnab method [4] to track by telephone follow-up. Assessment criteria: 1, excellent: no pain, no activity limitation, very satisfied; 2, good: occasional neck and shoulder pain and upper limb pain, but does not affect work and life, compared with the preoperative significantly improved, satisfied; 3, may be: significant improvement in function, but intermittent pain can be “tolerated”, slightly affecting the work and life, more satisfactory; 4, Poor: no improvement in pain and function, unsatisfactory. 2. Results: None of the 46 patients had complications such as hematoma, hemorrhage, intervertebral discitis, laryngeal nerve, superior laryngeal nerve injury, etc. 32 cases had immediate symptomatic relief after surgery, and the follow-up period was 3 months to 12 months, 38 cases were excellent, 4 cases were good, 2 cases were acceptable, and 2 cases were poor. 3.1 Cervical disc herniation is caused by degeneration of cervical intervertebral disc, which leads to herniated nucleus pulposus compressing the nerves and spinal cord, resulting in radiating pain in the upper limbs of the neck and shoulders, numbness, and sensory-motor disorders in the limbs. At present, there are various surgical methods for treating cervical disc herniation. Traditional anterior cervical disc removal surgery is highly traumatic, with many complications, high surgical risk, and postoperative bone grafting or no bone grafting can cause biomechanical changes in the cervical spine, and the minimally invasive surgeries commonly used belong to the ablation of the nucleus pulposus and reduction of the compression by chemical or physical factors, and the chances of disc reaction and nerve stimulation reaction are greater during and after the surgery. Nucleotomy with waterjet is a mechanical cutting technique, so there is no need to worry about physical and chemical damage to the intervertebral disc, especially the cartilage plate. At the same time, disc waterjet treatment does not destroy the soft tissues and bony structures of the neck as much as possible, which reduces the changes in the biological structure of the cervical spine and the chances of postoperative recurrence. 3.2. Experience The 46 patients in this group were operated on C3.4, C4.5, C5.6, C6.7, C6.7 protruding cases due to the shoulder obstruction during the operation, and sometimes the C-arm X-ray machine showed that the puncture interval was not exposed, such as forcible operation is easy to damage the cervical blood vessels, the dural sac, the tip of the lungs, resulting in hemorrhage, cerebrospinal fluid leakage, pneumothorax, and the patient’s two upper limbs should be pulled downward, so the patient’s head is tilted back, and when the puncture interval is fully exposed, the patient’s head is tilted back, and the patient’s head is tilted back. In this case, the patient’s upper limbs should be pulled downward, the patient’s head should be tilted back, and the operation should be performed when the puncture gap is completely exposed to ensure surgical safety. The degree of disc degeneration, the degree of herniation and the choice of surgical method and prognosis have a close correlation, most of the selected cases in this group are moderate degenerative discs, waterjet cutting suction through the removal of part of the nucleus pulposus tissue for mechanical decompression, the protruding discs are gradually returned to alleviate the pressure and irritation of the nerves. Especially in cases with large herniated material, disc waterjet can achieve ideal decompression effect. This study shows that percutaneous puncture waterjet nucleotomy and aspiration for cervical disc herniation is safe, minimally invasive, and has excellent clinical efficacy. Strictly mastering the indications is the prerequisite to ensure the efficacy of surgery.