Objective: To observe the clinical efficacy of DSA-guided percutaneous discectomy with microdiscectomy device, nucleotomy and ozone ablation with sacral injection in the treatment of lumbar intervertebral disc herniation (PLID). Methods: 67 patients with PLID were treated with a 17G microdiscectomy device under DSA surveillance and guidance in the ambulatory position, and the diseased disc was punctured with a 17G microdiscectomy device through the posterior part of the affected side at a distance of 8-10 cm from the posterior midline, and part of the Nucleus Pulposus (NPS) was excised from the disc, and then the core of the microdiscectomy device was withdrawn, and the NPS was injected with 20-30 ml of 60 μg/ml O3 through the sacral tube for the treatment of oxidative ablation of the remaining NPS, and then the sleeve was retreated to the area around the extradiscal nerve roots for the treatment of NPS. The concentration of 30μg/ml O3 10~20 ml for anti-inflammatory and analgesic treatment, and then withdraw the cannula to end the treatment. The sacral cleft was looked at and marked, and the sacral cleft was punctured with a 5 ml syringe prepared with lidocaine, confirming that the tip of the needle was in the sacral lumen, and pumping back without blood and cerebrospinal fluid, and then replacing the configured 20 ml of anti-inflammatory and analgesic solution was slowly injected. Results: In 67 cases of PLID, the success rate of puncture and technical operation was 100%. Postoperative follow-up time of 1 month, 3 months, 3 months to reach the best efficacy, according to Macnab efficacy assessment criteria, its excellent, good, available, poor were 53 cases, 9 cases, 4 cases, 1 case, respectively, the excellent rate of 92.5%, no complications. CONCLUSION: DSA-guided percutaneous discectomy with microdiscectomy device nucleus pulposus removal plus ozone ablation with sacral injection for PLID is a safe and effective method. DSA-guided; disc herniation; excision treatment; ozone; sacral canal treatment I. DATA AND METHODS 1. GENERAL INFORMATION Among the 67 patients, 46 were male and 21 were female; the maximum age was 57 years old, the minimum age was 21 years old, and the average age was 35.37 years old; the history of the disease ranged from 1 month to 2 years, and all the cases were examined with CT films or MRI films, as well as physical examination, etc. The treated interspaces were L3-4 9 interspaces, L4-5 51 intervertebral discs, L5S1 34 intervertebral discs, 67 patients with history, clinical symptoms, signs, imaging four consistent and, a clear diagnosis. Combined bony spinal stenosis, severe hypertrophy of the ligamentum flavum, small joint disorder syndrome, lumbar compression fracture, lumbar spondylolisthesis, bone tumor, severe calcification of the posterior longitudinal ligament, hyperthyroidism, and G-6PD deficiency were excluded. 2, equipment and materials DSA (digital subtraction X-ray machine) for the United States GE company production; the United States Stryker company produced the micro percutaneous discectomy device; Germany Herman company produced the cabinet ozone generator. 3, the surgical method (1) preoperative preparation ① preoperative should be explained to the patient the main methods of surgery, possible situations and how to cooperate, and dispel the patient’s fear. ② In order to correctly assess the patient’s tolerance of surgery, preoperative routine blood, urine, stool routine, blood coagulation index, blood sedimentation, blood glucose, electrocardiogram, preoperative control of sensory 9 and other tests, and routine preoperative preparation. ③The patients should be given bed bowel function training to keep the bowel clear. Those with dry stools should be given appropriate laxatives. (2) Surgical steps ① preoperative positioning: prone position, abdominal cushion soft pillow, so that the lumbar arched, the intervertebral space open, conducive to puncture. In the DSA fluoroscopy to determine the lesion of the intervertebral space, and draw a transverse marking line, from the spinous process line to the affected side of the paracentesis 8 ~ 10cm, parallel to the intervertebral space as the puncture point. ② anesthesia and puncture: 1% lidocaine local anesthesia at the puncture point, choose 617G discectomy device (straight) cannula and feed the core of the puncture needle, and the sagittal plane of the torso at an angle of 45 ~ 50 ° puncture, through the sacrospinous muscle, lumbar muscle, lumbar muscle inner edge of the triangle of the safety of the posterior lateral annulus of the fibers, at this time, there is a sense of toughness of the penetrator, fluoroscopy to determine the tip of the penetrator in the correct position. Confirm the position of the tip of the perforator after the posterior outer 1/4. ③ Replace the resector and advance it at a speed of 1mm per second to remove part of the nucleus pulposus tissue of the intervertebral disc. ④ Avoid inserting the resector too deeply during the operation, and keep changing the angle of the resector needle. ⑤ Remove the resecting cannula and inject 20-30 ml of 60 μg/ml O3 through the cannula for oxidative ablation of the residual nucleus pulposus. (6) Retreat the resection cannula to the periphery of the extradiscal nerve root and inject 10~20 ml of O3 with a concentration of 30 μg/ml O3 for anti-inflammatory and analgesic treatment. (7) Withdraw the resection cannula and apply a sterile dressing externally to the wound. (⑧) Look into the sacral cleft and mark it well, puncture the sacral cleft with a 5 ml syringe prepared with lidocaine, confirm that the tip of the needle is in the sacral lumen, withdraw no blood and cerebrospinal fluid, and then replace it with the configured 20 ml of anti-inflammatory and analgesic solution and inject it slowly [1]. 4, postoperative treatment ①After the operation, we should be absolutely bedridden for 5~7 days. ②Keep the bowels clear to prevent the disc from protruding again. ③ Instruct the patient to gradually carry out the functional exercise of lumbar and back muscles and lower limbs. ④Patients should routinely use 20% mannitol injection and broad-spectrum antimicrobial agents to prevent infection for 3 days after surgery. ⑤ Get out of bed after 1 week of bed rest and be supported with a lumbar girdle. The patients came to the hospital for review of CT or MRI films in 1 or 3 months to observe the therapeutic effect. Results: 67 patients in this group were treated with ozone injection for PLID by percutaneous puncture of lumbar intervertebral disc with microtome under DSA guidance, the success rate of puncture was 100%, and the weight of nucleus pulposus resection of each intervertebral disc ranged from 1 to 3.5 g, with an average of 1.9 g. The efficacy of the treatment was evaluated according to the Macnab efficacy evaluation standard, and the follow-up time was 1 month, 3 months, and the optimal effect was achieved at 3 months, which was excellent, good, feasible, or good. The results were 53 cases, 9 cases, 4 cases and 1 case respectively, with an excellent rate of 92.5% and no complications. Discussion Indications: ① with typical clinical symptoms of disc herniation, radicular pain symptoms. ② Confirmed by CT or MRI examination with clinical signs. ③ Ineffective after more than three months of regular conservative treatment. Contraindications: ① obvious narrowing of the intervertebral space, suggesting degenerative disc bulging. ② herniated disc combined with spinal stenosis, osteophytes or free bone mass, crypt stenosis and other comorbidities. (iii) Long history of herniated disc with calcification. Fibrous annulus rupture, the nucleus pulposus tissue into the spinal canal. ⑤ Those who have undergone intervertebral disc surgery. Those who have slipped out of the vertebral body. (7) Those with bleeding disorders. (8) Those who have undergone chemical nucleolytic surgery. ⑨ Hyperthyroidism, G-6PD deficiency. O3 principle of PLID treatment In the mid-1990s, Italian medical experts took the lead in Europe to introduce a new safe treatment method for PLID – “ozone intervertebral disc and paravertebral space injection”, which has been commonly used in European countries. This treatment method has the advantages of easy operation, small trauma, high safety, no toxic side effects and low cost compared with the traditional method. He Xiaofeng et al[ 2-3] believe that: ozone injection can rapidly oxidize the proteoglycans in the nucleus pulposus, so that the osmotic pressure of the nucleus pulposus is lowered, water is lost, and denaturation, drying, necrosis, and atrophy occurs, and eliminates the chemical irritation of the nucleus pulposus and the immunogenicity of the nucleus pulposus, and at the same time, due to ozone’s anti-inflammatory and analgesic effects, it is injected around the nerve roots, relieving the compression of the nerve roots, and relieving the symptoms of lumbar and leg pain. Ozone treatment is different from any previous treatments, it is a treatment with biological characteristics, which will not cause mechanical, high temperature and chemical side damage in the body, and will not produce serious complications and sequelae. However, some of the intervertebral discs retracted in O3 treatment is not satisfactory because: (1) the limited amount of O3 injection makes the nucleus pulposus oxidized insufficiently; (2) the effective rate of O3 treatment for disc herniation is only 72% [4]. Sacral therapy, referred to as “sacral therapy” that is, sacral drip therapy, also called sacral impact therapy, foreign countries called liquid knife therapy. Epidural drug injection can eliminate the congestion and edema around the nerve root, loosen the adhesion around the nerve root, reduce the irritation of the nerve root and relieve the pain. The drug is injected into the epidural cavity through the sacral canal, directly acting on the dura mater and nerve root, blocking the conduction pathway of pain and its vicious circle, relieving the muscle and vascular spasm of the lesion site, promoting local blood circulation, facilitating the absorption and excretion of inflammatory substances, and playing a role in eliminating pain. Trimethoprim has the effects of anti-inflammation, reducing edema, and preventing adhesion; B vitamins have the effects of nourishing nerves and promoting the repair of soft-tissue lesions; and lidocaine can inhibit the sensitivity of nerve endings, and play the roles of analgesia and relieving muscle spasms. In conclusion, DSA-guided percutaneous discectomy with microdiscectomy device, nucleus pulposus removal and ozone ablation with sacral injection for PLID can achieve the quadruple therapeutic effect of microdiscectomy plus ozone ablation, peridiscal anti-inflammation and analgesia, and sacral treatment, which is light on the destruction of spinal stability, easy to operate, safe, with reliable efficacy and few complications, and it is one of the effective methods of treating PLID.