Is aseptic inflammation the culprit of low back pain (lumbar synostosis)? Society is developing and technology is improving, which is a good thing for human civilization and progress, but it also improves human inertia, and people are more and more reluctant to move, preferring to sit for long periods of time to work, play with computers, surf the Internet, and pass the time, not knowing that it is this way of life and work that makes the incidence of lumbar synostosis patients also higher and higher. Patients with lumbar synostosis can have clinical back pain and radiating pain in the lower extremities, which interferes with the normal life and work of patients and their families. In severe cases, the severe pain can cause patients to lose their confidence in life! In our CT-guided interventions, the youngest patient cured was 13 years old. People have the traditional and customary notion that “lumbar pain is caused by a herniated disc pressing on a nerve”, and that the pain will disappear if the patient undergoes surgery to remove the herniated part of the disc. However, in the actual clinical work, these patients still have herniated discs after CT and MR examination after surgery. Some patients with bulging discs have the same clinical symptoms of low back and leg pain as those with herniated discs, even though the CT and MR findings do not compress the nerves. Patients who have undergone surgery may have the same preoperative symptoms of low back and leg pain after recurrence, despite the fact that the “herniated disc was removed”. Patients with lumbar herniation have been treated with CT-guided pharmacological interventions to eliminate the patient’s low back and leg pain, but the herniated disc does not change in imaging…. A meditative analysis of the above causes makes us think deeply and confused about what causes low back and leg pain in patients with lumbar herniation. Although the mechanism of pain production is not very clear and controversial. However, there are three main theories (causes) of low back pain in lumbar synostosis; 1. the chemical radiculitis theory. 2. the autoimmune theory. 2. Autoimmune theory. 3, mechanical compression theory. By summarizing the clinical experience of patients with lumbar synostosis who had low back pain in the past 20 years after CT-guided drug interventions, we believe that chemical radiculitis (aseptic inflammation) is the main cause of lumbar synostosis producing low back pain. Where exactly do those chemical substances come from? The intervertebral disc is located between the bony vertebral bodies. The normal intervertebral disc is a sealed compartment, consisting of the fibrous ring, the nucleus pulposus, and the cartilage end plate, and for easy understanding, we describe the disc tissue as an egg; the peripheral fibrous ring is like a protein, the central nucleus pulposus is like an egg yolk, and the fibrous ring is divided into inner, middle, and outer layers, like an onion, which closely and layer by layer wraps the nucleus pulposus in the center, and the nucleus pulposus tissue is very much like the jelly we usually eat The nucleus pulposus is very much like the jelly we usually eat, white and sticky jelly-like. Foreign scholar Peyron believes that the nucleus pulposus contains a variety of proteolytic enzymes (collagenase, gelatinase, elastase, phospholipase A2, etc.). These proteolytic enzymes are chemical substances, which means that the chemical substances come from the nucleus pulposus. The normal onion-like fibrous ring is sealed and intact, and these enzymes are closed inside the fibrous ring and no chemical reactions occur. How does back and leg pain occur? The annulus fibrosus of the intervertebral disc is circular and wraps the nucleus pulposus in the center. The thickness of the annulus fibrosus varies in the anterior, posterior, left and right directions, with the annulus fibrosus being thinnest in the posterior part of the disc, where the spinal canal is located and the sciatic nerve is located in the spinal canal. Most of the intervertebral disc’s annulus fibrosus ruptures from the weak posterior side, and after the rupture, various proteases within the nucleus pulposus spill into the spinal canal at the posterior side of the disc. In layman’s terms, if the disc is compared to a car tire, the fibrous ring of the disc is like a tire, and the nucleus pulposus is like the gas in the tire. When the car tire is aging and leaking, once the gas (various proteases) is released from the intervertebral disc, it is like “Pandora’s Box” being opened, causing a chemical inflammatory reaction in the lumbar tissues; muscles, fascia, blood vessels, etc., that is, aseptic inflammation, at this time the patient has clinical symptoms of lumbar pain, and if the inflammation continues to spread If the inflammation continues to erode the sciatic nerve, the patient will develop radiating pain in the lower extremities, that is, sciatic neuritis. This means that lumbar pain in patients with lumbar synostosis is caused by the rupture of the intervertebral disc’s annulus fibrosus, and the nucleus pulposus overflows and exudes from the ruptured annulus fibrosus. What is the correlation between the severity of pain and the severity of low back pain? The degree of back and leg pain is related to the amount of chemical substances released, which is proportional. In other words, the larger the rupture of the annulus fibrosus, the more chemical substances are released, and the more severe the pain is! This explains why many patients with severe disc herniation compressing the sciatic nerve on imaging have no significant symptoms of low back pain. A bulging disc can have severe back and leg pain without compressing the sciatic nerve! In other words; the clinical symptoms of the patient are not related to the degree of disc herniation, but to the size of the disc rupture and the amount of inflammatory exudation. So eliminating the inflammation can achieve to reduce and eliminate the patient’s back and leg pain! Patients with lumbar herniation with early lumbar pain and mild lower limb radiating pain can eliminate inflammation by traditional conservative treatment such as acupuncture, traction, medication, hot compresses, physical therapy, etc. After one month of conservative treatment, if the clinical symptoms cannot be relieved, patients can do CT-guided drug intervention. Since the rupture of the disc is at the posterior edge of the vertebral body, the location is deep and the anatomical structure is complex, with dural sac, nerve roots, small joints, ligaments and other tissues, and with little blood supply to the disc, it is generally difficult for anti-inflammatory drugs to reach the rupture of the disc. Under CT guidance, the puncture needle precisely avoids the sciatic nerve, small joints, and dural sac, and injects a small amount of medication directly and directionally into the surface of the disc rupture to effectively eliminate the inflammatory material at the disc rupture, and as the inflammatory material is reduced and eliminated, the patient’s back and leg pain symptoms are reduced and eliminated. This treatment is like watering a flower by pouring water directly on the roots of the flower.