The pathogenesis of lumbar disc herniation is due to the imbalance of the biomechanical balance of the lumbar spine, resulting in degeneration of the lumbar disc, rupture of the fibrous ring, protrusion of the nucleus pulposus, mechanical compression of the nerve roots and chemical stimulation of the protruding material causing lumbar pain and conduction block, in clinical work it is advisable to take different treatment methods according to the patient’s condition – ladder treatment, in order to improve the efficacy and minimize the patient’s medical expenses The lumbar intervertebral disc herniation is currently the more standardized treatment method: 1, conservative treatment: 1, bed rest Bed rest can remove the pressure of weight on the lumbar intervertebral disc, which is conducive to venous reflux around the disc, eliminating edema, accelerating inflammation, and avoiding nerve root stimulation by repeated vibration of the lumbosacral nerve in the spinal canal when walking or exercising, but long-term bed rest can cause disuse muscle atrophy and osteoporosis, therefore, absolute After being bedridden, functional exercise of lumbar and back muscles can be carried out in bed, which can prevent adhesions by pulling the nerve roots and prevent recurrence by enhancing the muscle strength of lumbar and back muscles. 2, drug treatment Drug treatment is mainly used as an auxiliary treatment method, in the treatment of acute lumbar disc herniation, the application of dehydration, anti-inflammatory, blood-activating drugs can quickly eliminate or reduce the inflammatory exudation and edema around the nerve root, and can improve the blood circulation in the focal area, increase tissue nutrition or metabolism, accelerate or promote the release and excretion of pain-causing mediators, so as to play an anti-inflammatory, eliminate edema, antispasmodic and analgesic The effect is conducive to the recovery of lumbar function and lay the foundation for further treatment. Traction, massage and acupressure can widen the intervertebral space, reduce the internal pressure of the intervertebral disc, and the bulging disc can be retracted or partially retracted into the intervertebral space due to the attraction of negative pressure, and can release the spasm of the lumbar back muscles, so that the corresponding neurovascular function can be improved. Tui-na and massage can reduce the symptoms by relaxing the muscles, relieving the spasm, increasing the local blood circulation, accelerating the absorption of edema around the nerve root and changing the relationship between the protrusion and the nerve root to obtain the analgesic effect. 4.Physical therapy Some studies show that high-frequency electrotherapy such as ultra-short wave and microwave is used in the acute inflammation period of lumbar disc herniation, which can improve blood circulation in deep tissues, reduce edema, promote the elimination of inflammatory metabolites and relieve vascular spasm, and low-frequency pulse electrotherapy, computerized medium-frequency electrotherapy and far-infrared heat therapy are used in the chronic recovery period, which can stimulate sensory and motor nerves to achieve sedation and pain relief, promote It can stimulate the sensory and motor nerves to achieve sedation and pain relief, promote the recovery of nerve function, soften the scar and loosen the adhesions. 5.Epidural cavity, sacral canal injection and paravertebral block therapy Corticosteroid drugs with strong anti-inflammatory effects such as tretinoin and Depo-Provera are injected into the epidural cavity, sacral canal or paravertebral muscle, which can inhibit the production of inflammatory mediators such as prostaglandins, histamine and bradykinin, suppress local autoimmune reaction, reduce capillary permeability, improve local blood circulation, play anti-inflammatory, anti-allergic, eliminate edema, and inhibit the proliferation of fibroblasts and stop the proliferation of fibroblasts. Fibroblast proliferation, stop muscle damage inflammation caused by muscle spasm, achieve the effect of pain relief and improve local blood circulation, so as to alleviate the symptoms of acute phase of low back pain and leg pain. Minimally invasive percutaneous treatment: 1. Chemical myelolysis In 1963, Smith injected papaya curd proteinase into the intervertebral disc by percutaneous puncture for the first time, which pioneered the chemical myelolysis. As the main component of the intervertebral disc is collagen, collagenase can selectively destroy and dissolve the collagen in the nucleus pulposus and fibrous ring, reduce the pressure of the intervertebral space and make the protrusion retract, thus achieving the purpose of relieving nerve compression and improving clinical symptoms. 2.Ozone ablation treatment Ozone is a strong oxidant that can stimulate the expression of antioxidant enzymes. Ozone ablation can oxidize and decompose proteoglycans in the nucleus pulposus, oxidize or destroy the structure of the nucleus pulposus, shrink the volume of the intervertebral disc, retract the fibrous ring, and return the herniated object, thus relieving the compression of the herniated disc on the nerve root. At the same time, by antagonizing the release of immune factors in the inflammatory response, dilating blood vessels, improving venous return, reducing nerve root edema and adhesions, promoting inflammation absorption, and thus relieving pain. 3.Intradiscal electrothermal therapy (IDET) IDET mechanism of action, firstly, local high temperature leads to contraction of collagen fibers in the annulus fibrosus tissue, which promotes the healing of the fissured annulus fibrosus and reshapes the intervertebral disc; secondly, local heating inactivates the outer 1/3 sinus N endings of the annulus fibrosus, destroys pain transmission pathways, blocks pain signal transmission, and thus achieves pain control; thirdly, it destroys pain-causing factors in the intervertebral disc and improves the pain absorption. IDET can better maintain the normal structure of the lumbar spine, the stability of the spine and weight-bearing capacity. 4.Percutaneous plasma radiofrequency ablation (CN) CN by virtue of 40℃ low-temperature radiofrequency energy cuts multiple orifices inside the nucleus pulposus, removes part of the nucleus pulposus tissue, and uses 70℃ thermal coagulation to vaporize, contract and solidify the collagen fibers in the nucleus pulposus, which reduces the total volume of the intervertebral disc, thus reducing the pressure inside the disc and alleviating the irritation of the disc tissue to the nerve roots to achieve the treatment purpose. Indications: mild to moderate disc herniation, history of low back pain, conservative treatment for more than 2 months is ineffective, neurogenic symptoms of leg pain are greater than low back pain, positive straight leg raise test, imaging confirmed small herniation (<6mm), discogenic low back pain, simple lumbar disc bulging and herniation without rupture of the annulus fibrosus. 5, percutaneous laser disc decompression (PLDD) PLDD is to use the high-energy local biological effect of laser, namely burning, vaporization, denaturation and coagulation to "remove" the herniated disc nucleus pulposus, reduce the pressure in the diseased disc, make the herniated disc retract, reduce the pressure on the spinal cord and nerve roots, eliminate back and leg pain, and achieve the purpose of treatment. PLDD does not affect the stability of the spine, no postoperative scar or adhesion formation, and does not affect future spinal surgery decompression and reconstruction surgery. Endoscopic techniques: 1. Total endoscopic lumbar disc removal This procedure has emerged in China in less than a few years, but it has shown more advantages. However, Ruetten et al. also did an extension of total endoscopic treatment of disc surgery for cervical disc herniation and also obtained significant results. Compared with traditional surgery, total endoscopic cervical disc removal with less trauma, fewer complications and faster postoperative recovery. 2. Minimally invasive posterior discoscopic surgery (MED) is performed through a minimally invasive orifice with limited expansion of the paravertebral muscles only, biting off a small portion of the edge of the vertebral plate, and removing the compression-causing and stenosis-causing material with the help of the endoscope. MED has the advantages of less trauma, clear anatomy, and faster postoperative recovery, and maintains maximum stability of the lumbar spine, reducing the incidence of postoperative complications such as spinal slippage and lower back pain, especially in reducing the incidence of postoperative adhesions, with an excellent rate of 92,8 The excellent rate can reach 92,8%, especially in reducing the occurrence of postoperative adhesions. 3, percutaneous endoscopic technique (TELD) TELD is the most promising minimally invasive surgical technique developed in recent years, which uses a set of special equipment and instruments to remove the protruding disc tissue through the intervertebral foramen to achieve decompression and release of the dural sac and nerve roots, TELD generally uses local anesthesia, which can effectively avoid damage to the nerve roots during surgery, while removing the disc tissue, without The removal of the disc tissue, while not removing the ligamentum flavum and the vertebral plate, does not destroy the posterior stability of the spine, compared with MED or open surgery, the damage is smaller, more in line with the concept of minimally invasive treatment of the spine. Traditional open surgical treatment: 1. Small open window surgery Small open window nucleus pulposus removal is one of the limited invasive surgical methods commonly used and effective in the treatment of lumbar disc herniation, in which a posterior median incision of about 3 to 100 px is made with the diseased vertebral space as the center, the skin, superficial and deep fascia are incised in turn, the affected sacrospinal muscles are stripped, the intervertebral space is exposed, the soft tissue of the intervertebral space is scraped away with a scraping spoon, and the intervertebral space is completely exposed. The intervertebral space is completely exposed, and the intervertebral space is expanded into a 50px×37,5px bone window to reveal the herniated disc and remove the nucleus pulposus. The small open window procedure has the advantages of small incision, less bleeding, less trauma and less postoperative complications in the treatment of lumbar disc herniation. 2.Hemilaminectomy hemilaminectomy preserves the supraspinous and interspinous ligaments, strips the unilateral paravertebral muscles, and enters the spinal canal after appropriate enlargement of the lateral aspect of the ligamentum flavum and bite off the superior and inferior laminae of the diseased space along the inner edge of the small joint. If the lateral saphenous fossa is found to be stenosed, a small bone knife can be used to subconsciously chisel away the hyperplasia of the lateral saphenous fossa and expand the lateral saphenous fossa to achieve the purpose of relieving and decompressing the nerve root. 3.After satisfactory decompression of the whole lamina, the occluded bone is preserved, the intervertebral discs are removed and the intervertebral space is properly propped up, the pre-curved fixation bar is installed, the upper and lower end plates are trimmed with a reamer to make the surface rough, the occluded spinous process and the lamina bone are trimmed into a 15mm×8mm bone block, and the rest are small bone particles of 3-5mm in diameter, and a funnel is used to press the bone implant. Finally, the trimmed bone block was sealed and knocked down to 3,0-4,0 mm in front of the posterior edge of the vertebral body, and then the pedicle screws were pressed together along the fixation bar to stabilize the interbody bone graft. V. Non-fusion technology dynamic stabilization system: 1. Coflex implantation system Coflex implantation system is a non-fusion technology based on the concept of dynamic internal fixation, so that the stability and mobility of the lumbar spine are maintained, and the stress distribution is closer to the normal human state by propping up the spinous process and maintaining a moderate flexion position of the lumbar spine, which is a non-fusion technology of internal fixation in the spinous process, preserving beneficial motion and It is a non-fusion technique for interspinous fixation that preserves the stabilization system for beneficial motion and intersegmental load transfer without fusion of the vertebral segments. Biomechanical studies have shown that Coflex implantation has no significant effect on flexion, lateral bending and rotational mobility of the fixed segment and adjacent upper and lower segments, except for the limitation of posterior extension of the fixed segment. 2.Dynesys implantation system Dynesys is a dynamic neutral fixation system for the treatment of lumbar degeneration and instability. It uses titanium pedicle screws connected by a polyethylene terephthalate band between the screws and a tubular cuff of stiffer polycarbonate-type polyurethane between the connecting bands, which allows it to function as a fixation system while maintaining anterior lumbar convexity and mild separation of the spine. Dynesys can maintain a certain degree of mobility and local anterior convexity of the fixed segment while limiting abnormal motion of the unstable segment. Although the former has been introduced into the clinic, there is no clear clinical efficacy due to the surgical access, selection of indications, postoperative complications and other aspects. The artificial nucleus pulposus prosthesis can absorb water and swell and harden, similar to the normal intervertebral disc, and the liquid-like nucleus pulposus rotation center is floating, so that it can move with the change of stress, which can effectively restore the function of intervertebral disc and maintain the height of intervertebral disc, which can not only relieve the symptoms of lumbar and leg pain and remove the discogenic pain, but also maintain the normal motion function between vertebrae and restore the biomechanical relationship, which is the development of the treatment of lumbar disc herniation. It is the direction of the development of lumbar disc herniation treatment. It is believed that with the progress of science and technology, the deeper understanding of lumbar disc herniation and the accumulation of clinical experience, the treatment methods with less trauma, high safety and reliable efficacy will be more often used in clinical practice.