Radiofrequency therapy instrument is to insert a transmitting electrode into the lesion site, with another electrode to receive, when the radiofrequency through the lesion tissue to produce biological effect, this biological effect is mainly thermal coagulation. The main component of intervertebral disc is collagen, mucopolysaccharide, chondroitin sulfate and other protein components, using the thermal principle of radio frequency, change the structure of the protein, make it denaturation, solid shrinkage, and at the same time there can be “welding” intervertebral disc rupture, so as to reduce the compression of the nerve root, reduce the symptoms; then is the high local heating temperature of 92 ℃ The local heating temperature is 92℃, which can destroy the sinus nerve endings in the lesion area, thus stopping the pain; the herniated disc can cause local compression leading to sterile inflammatory reaction, and the high temperature can inactivate the inflammatory medium; the warming effect can increase the epidural blood circulation, which has a similar effect to physiotherapy and facilitates the absorption of sterile inflammation. Yang Cheng, Department of Traditional Chinese Medicine and Orthopedics, Gucheng County People’s Hospital (II) Indications: simple lumbar disc herniation. (C) relative indications 1, lumbar disc herniation, recurrence after surgical treatment; 2, lumbar disc herniation with partial calcification; 3, lumbar disc herniation diameter greater than 10mm; 4, lumbar disc herniation after one treatment to reduce symptoms, the second treatment can be made as appropriate. (D) contraindications: 1, combined with bony spinal stenosis or hypertrophy of the ligamentum flavum; 2, combined with severe cauda equina symptoms; 3, calcification or ossification of the herniated disc; 4, slippage of the vertebral body of degree II or above; 5, bleeding tendency; allergy; 6, psychiatric or intraoperative patients who cannot cooperate; 7, serious organic disorders of the heart, liver, lung and brain. (E) The choice of radiofrequency ablation method: 1, simple lumbar disc lateral posterior herniation, accompanied by one side of the lower extremity radioactive sciatica, preferred stereotactic target ablation. 2, bulging or central type herniation, lower back pain or alternating sciatica of both lower limbs, intra-disc ablation is preferred. 3.Select the puncture route according to the protrusion site, and use the medial margin of the small joint for puncture, or use the intervertebral foramen for safe triangular puncture to enter the needle. 4.If the ablation effect of protrusion diameter greater than 10mm and prolapse type is not satisfactory, repeat treatment and ozone and other methods can be used as appropriate. (6) Radiofrequency ablation operation methods and steps 1. Pre-operative preparation ① Carefully read the film, determine the width, height and length of the protrusion, determine the location of the target point, and formulate the puncture treatment plan (puncture route and needle depth). ② Introduce the treatment method to the patient, eliminate preoperative tension, and give appropriate amount of sedative and analgesic before surgery. 2.Radiofrequency ablation at the medial margin of the small joint: ① Positioning and local skin disinfection: The patient lies on the fluoroscopy bed, and the corresponding vertebral space is opened 0~2cm in the midline, and the puncture point is marked with gentian violet. Disinfect the skin with the puncture point as the center, and lay a disinfectant towel. ② Local anesthesia: local anesthesia is done layer by layer with 1% lidocaine from the puncture point, and it is not appropriate to anesthetize the nerve root. ③ Puncture: locate the puncture point through the skin, use a radiofrequency puncture needle, enter the needle vertically or at an angle, and puncture through the skin, subcutaneously, through the ligamentum flavum, the spinal canal, and enter the needle between the ligamentum flavum and the dural sac, and aim at the corresponding protrusion target. Avoid puncturing the dural sac as much as possible. ④Position of the needle tip: The tip of the needle is located at the medial edge of the pedicle within the intervertebral disc in frontal fluoroscopy. The tip of the lateral fluoroscopic needle is located within the intervertebral herniation so that the front end of the adiabatic lacquer of the puncture needle is located exactly at the posterior edge of the herniation. The formula can also be used to calculate: A=B-0.5CM where A is the distance of the needle tip from the posterior edge of the upper and lower vertebral body, B is the distance between the protrusion and the line of the posterior edge of the upper and lower vertebral body, and 0.5cm is the length of the exposed end of the puncture needle. ⑤ Nerve test: remove the needle core, put in the electrode, and perform a sensory-motor test: if there is a strong numbness or muscle twitch response, the needle tip position can be adjusted. Impedance value test, generally between 150-250. (6) Heating and ablation: sequentially heating 66℃, 76℃, 86℃ for 30S each, 90℃ or 92℃ heating for 180S. In the process of heating up the original pain area heat, burning sensation that induces the original pain is more effective, the pain is severe to terminate the heating, adjust the needle tip position, reheat. Multiple target points can be repeated several times. (⑦) The treatment is over, use a band-aid to dress the eye of the needle. ⑧Postoperative position: keep lying down or prone position. 3.Intradiscal radiofrequency ablation operation method: ① Positioning, local skin disinfection: the patient lies on the examination bed, abdomen is padded with a pillow, the corresponding vertebral space is opened 6-10cm to the affected side in the midline, and the puncture point is marked with gentian violet. The skin is disinfected and a sterile towel is laid. ② Anesthesia: 1% lidocaine as local anesthesia. ③ Puncture: from the skin marking point, the needle body is at an angle of 45º to 60º with the lumbosacral area, and punctured against the corresponding vertebral space. l5~S1 intervertebral disc is punctured with the needle body tilted to the cephalad side at about 20º to 25º, and there is an astringent sensation when the needle tip punctures the fibrous ring. ④ Fluoroscopic needle tip position: the tip of the needle reaches the medial margin of the affected small joint in the orthotropic position and is located at the junction of the middle and posterior 1/5 of the intervertebral disc in the lateral position. ⑤ Nerve test: remove the needle core, put in the electrode, and perform a sensory-motor test: if there is a strong numbness or muscle twitch response, the needle tip position can be adjusted. Impedance value test, generally between 150-250. (6) Heating and ablation: sequentially heating 66℃, 76℃, 86℃ for 30S each, 90℃ or 92℃ heating for 180S. In the process of heating up the original pain area heat, burning sensation that induces the original pain is more effective, the pain is severe to terminate the heating, adjust the needle tip position and reheat. Multiple target points can be repeated several times. ⑦ Position: keep lying down or prone position. Postoperative treatment: ① Return to the ward after surgery to maintain the required position for rest, observe the body temperature, pulse, respiration, heart rate, and any allergic reaction. ②Patients are required to stay in bed absolutely for 6h after surgery, either in a flat or prone position, and can wear a lumbar brace to get out of bed only after 6h, and minimize getting out of bed within three days. ③Patients should wear a lumbar girth when getting out of bed after surgery, and symptomatic treatment can be carried out according to the postoperative reaction. Complications and treatment: Radiofrequency ablation is less traumatic and has fewer complications. The common complications are as follows: 1. postoperative pain reaction ① degree: the severity varies and varies from person to person. ②Regulation: After target point injection, the symptoms can often be relieved, but the symptoms are aggravated 2 to 3 days after surgery and gradually relieved after 1 week. ③Time: Some patients can have their symptoms relieved after surgery, and some patients have an increased pain reaction after surgery, which usually lasts for about 1 week and relieves itself. The pain reaction can last for about 3 weeks in individual patients. ④Patients with heavy pain reaction, postoperative oral painkillers, lumbar wet and hot compresses, sedative mannitol, compound salvia injection and other measures to improve microcirculation, nerve nutrition, reduce nerve root edema, etc. to relieve symptoms. 2, lower limb numbness: general numbness area in the original pain area, probably with the thermal effect on the nerve damage, mostly last 3-7 days, disappear on their own. Methylcobalamin, vitamin B1, etc. can be added. 3, nerve injury: no nerve root injury has been reported, but pain reflex occurs when the needle tip touches the nerve during puncture, which cannot be forcibly punctured, and the direction of the needle tip should be adjusted and punctured again. 4.Vascular injury: No death caused by vascular injury has been reported. Small veins may be damaged during the operation, and a small amount of bleeding does not require special treatment, but the puncture direction needs to be adjusted. 5, dural sac injury, a few patients have dizziness and nausea, which disappeared after symptomatic treatment with fluids, but there is no clear report related to this. Efficacy evaluation: Our hospital used this technique to treat more than 200 patients with disc herniation, and the total efficiency was over 90%.