Low back pain is one of the diseases that seriously affects patients’ daily work and life, especially in the middle-aged and elderly population, where the incidence of low back pain can be as high as 60%-80% or more. Mild low back and leg pain can be relieved mostly by conservative treatments such as bed rest, acupuncture, massage and physical therapy, but for chronic severe low back and leg pain, especially in cases with definite disc herniation, surgery is often the most effective method and the ultimate choice for patients. Most traditional surgical procedures are open surgeries that require removal of the disc and internal fixation of the spine, which are generally more traumatic, bleed more, require destruction of the spinal structure, slow recovery, and have more complications that patients are often reluctant to accept. In recent years, with the advancement of medical technology, there are many new minimally invasive surgical procedures gradually applied in clinical practice, which are especially suitable for middle-aged and elderly patients with back and leg pain, and have also achieved satisfactory results. Injections are the most simple and easy to use minimally invasive treatment method. In recent years, injection therapy has been very different from the traditional nerve sealing and blocking treatment in terms of technical means and technical connotation. Nowadays, injection therapy mainly refers to percutaneous puncture minimally invasive analgesic interventions under X-ray, CT, ultrasound or navigation guidance, and the injection sites can be various parts of spinal nerves, small joints, intervertebral foramina, epidural cavity, intervertebral disc or vertebral body; the materials used for injection therapy are no longer limited to local anesthetics, B vitamins and hormones, but also collagenase, ozone, radiofrequency, laser, bone cement, etc. The materials used for injections are no longer limited to local anesthetics, B vitamins and hormones, but also collagenase, radiofrequency, ozone, laser, bone cement, etc., and are often applied in combination to obtain better pain relief, such as radiofrequency ablation + ozone. Radiofrequency treatment seems to be more acceptable and has satisfactory efficacy for patients with low back pain. Radiofrequency therapy can generally be divided into continuous radiofrequency therapy and pulsed radiofrequency therapy. Continuous radiofrequency is the use of high frequency continuous current to produce high temperature effect at the tip of radiofrequency needle, and precisely control the temperature height and duration by radiofrequency instrument, also called radiofrequency ablation or radiofrequency thermal coagulation. The temperature can generally be as high as 75℃-85℃ to ablate the disc nucleus pulposus tissue or destroy the spinal nerve, and also to perform nucleoplasty or annuloplasty. Pulsed radiofrequency is a new technology developed on the basis of continuous radiofrequency for the treatment of chronic pain, using pulsed radiofrequency current to form a high voltage near the tip of the radiofrequency needle, which exerts a long-lasting analgesic effect through the neuromodulation mechanism. Since the temperature generally does not exceed 42℃, it does not destroy the function of sensory-motor nerves, and postoperative hyperalgesia or motor dysfunction rarely occurs. Most of the methods currently used in China are continuous radiofrequency temperature-controlled thermocoagulation. We have performed radiofrequency ablation of intervertebral discs, nucleoplasty and fibroelastoplasty under CT guidance in more than 100 cases according to different etiologies and types of low back and leg pain, and the efficiency rate at 6 months after surgery is more than 80%. In addition, for elderly patients with pain in the medial branch of the spinal nerve, radiofrequency thermocoagulation was used to destroy the medial branch of the spinal nerve in the corresponding segment, and more satisfactory results were also achieved. Most elderly people have osteoporosis and are prone to lumbar compression fractures due to trauma and strain, which is one of the common causes of back and leg pain in the elderly. For such patients, percutaneous vertebroplasty is a good minimally invasive surgical treatment option available. Percutaneous vertebroplasty is the percutaneous puncture of the vertebral arch or direct puncture of the vertebral body to inject bone cement into the vertebral body to increase the strength and stability of the vertebral body, prevent collapse of the vertebral body, and reduce compression of the intervertebral disc. This procedure should be performed under real-time fluoroscopic guidance and monitoring of the C-arm or DSA machine to avoid leakage and displacement of the bone cement as much as possible. Second, spinal endoscopic surgery spinal endoscopic surgery is the main symbol of the development of minimally invasive spinal surgery, according to the specific surgical access, can be divided into discoscopic surgery and intervertebral foraminoscopic surgery. While discoscopic surgery was first performed in the late 1960s, foraminoscopic surgery began to be used in clinical practice nearly 30 years later, but brought about a new climax in the development of minimally invasive spinal endoscopic surgery. Foraminotomy is a lateral-posterior or posterior foraminal approach that removes the herniated disc tissue in blocks outside the safety triangle of the foramen and the intervertebral disc annulus fibrosus. Depending on the specific operating technique and surgical steps, it can be further subdivided into YESS surgery and TESSYS surgery, and even the surgical instruments may differ between the two procedures, but they should actually be collectively referred to as percutaneous foraminoscopic disc removal. Percutaneous foraminoscopic disc removal is performed under local anesthesia, mostly in the prone position, without removing the lamina, rarely damaging the paravertebral muscles and ligaments, and maximizing the stability of the spine, with the advantages of less bleeding, less trauma, faster recovery, higher efficiency, more definite efficacy, and fewer complications. We have experience with more than 200 cases, and the pain disappeared or was significantly relieved in more than 85% of the cases after surgery, without serious complications, which is basically consistent with foreign literature reports. In addition, compared to traditional microsurgical disc removal, percutaneous foraminotomy is not only comparable in terms of surgical efficacy, but also has significant advantages in terms of complications, rehabilitation, postoperative lower back pain, and patient mental burden. Of course, percutaneous foraminoscopic disc removal also has some limitations, such as multi-segmental disc herniation, bilateral disc herniation, significant ligamentum flavum ossification, severe osteoporosis, severe foraminal stenosis and spinal stenosis, etc., which may affect the operation and treatment effect, and these conditions are more or less combined in elderly patients with low back pain. Neuroelectrical stimulation is a minimally invasive surgical pain relief procedure that has been widely recognized and professionally promoted in the past ten years or so. By implanting stimulation electrodes and pulse generators in the body, electrical stimulation is used to modulate the conduction, presentation and formation of pain sensation to achieve the effect of reducing or eliminating pain. Depending on the site of electrical stimulation, it can be divided into different procedures such as peripheral nerve electrical stimulation, spinal cord electrical stimulation, deep brain electrical stimulation and motor cortex electrical stimulation. Neuroelectrical stimulation not only has the advantages of minimally invasive surgery without destroying and damaging nerves, but also has the advantages of being programmable, testable and reversible, all of which are more favorable for application in elderly patients with low back pain. The most common procedure suitable for the treatment of low back pain in the elderly is spinal cord electrical stimulation, and the main indications include lumbosacral pain after lumbar spine surgery, complex regional pain syndrome, neuralgia after herpes zoster, pain after peripheral nerve injury, limb ischemic pain, etc. In Europe and the United States, spinal cord electrical stimulation is most used for postoperative pain after lumbar spine surgery, also known as failed back surgery syndrome. In China, on the other hand, the most important indication is neuropathic pain from various causes. The procedure is performed under local anesthesia and can involve either percutaneous puncture for implantation of needle electrodes or minimally invasive surgical incision of the interspinous ligament and the ligamentum flavum for implantation of surgical electrodes in the form of strips, which actually provide better coverage than puncture electrodes, with a wider variety of electrode shapes and contact combinations available, and are also more conducive to secure fixation and placement in place. Most of the procedures are performed in stages, with the first stage implanting stimulation electrodes for in vitro stimulation testing to observe the efficacy, and then the second stage implanting stimulation pulse generators for long-term in vivo stimulation treatment if the results are satisfactory. The stimulation pulse generator needs to be replaced every 5-8 years, but now there are pulse generators that can be recharged by remote sensing in vitro for clinical use, bringing greater convenience to patients. In recent years, we have completed more than 50 cases of spinal cord electrical stimulation using surgical stimulation electrodes for the treatment of various causes of geriatric low back pain, with an overall efficiency of more than 80%, especially for complex regional pain syndrome and pain after peripheral nerve injury with the most satisfactory results. In addition, the long-term efficacy of spinal cord electrical stimulation is also stable and accurate, and has become an important method for the treatment of chronic low back and leg pain, but the relatively expensive cost affects its wide application. The treatment of low back and leg pain is an important part of clinical work that cannot be ignored. If the treatment can eliminate low back and leg pain in a precise, effective, simple and minimally invasive way, the quality of life of patients will be greatly improved. With the development of medical technology and the advancement of treatment concept, it is believed that more patients with low back and leg pain will be happy to receive various minimally invasive surgical treatments. New minimally invasive surgical procedures such as percutaneous puncture injection therapy, spinal endoscopic surgery and nerve electrical stimulation have the advantages of small incision, low bleeding, fast recovery, safety and effectiveness, which not only provide new methods for minimally invasive surgical treatment of low back and leg pain, but also represent the advanced technology and development trend of minimally invasive surgical treatment of pain, which will be continuously improved and enhanced in the process of clinical promotion and application. In particular, the development of spinal endoscopic technology is not only endoscopic disc removal, but also more new procedures such as endoscopic laminectomy, endoscopic intervertebral fusion, endoscopic spinal internal fixation, etc., which will continue to expand the indications and clinical applications of spinal endoscopic surgery for the benefit of patients with low back pain.