How much do you know about minimally invasive spine surgery techniques — fully endoscopic lumbar fusion He Erxing, Department of Spine Surgery, The First Hospital of Guangzhou Medical University, Guangzhou, China Endoscopic tool system can provide surgeons with a good field of vision, fine tools require surgeons to operate as if sculpting, and patients do not have to be directly exposed to deep wounds, these factors make this surgical technique safer, minimally invasive and precise, and complications especially surgical infections are rare. The use of endoscopic tool systems in the field of minimally invasive spine surgery is important, and their successful application is the key to the maturity of minimally invasive techniques. Many diseases of the lumbar spine, such as severe disc herniation, spinal stenosis, lumbar spondylolisthesis, orthopedic spinal deformities, etc., require the use of lumbar spinal fusion. Traditional open lumbar interbody fusion requires the nerve tissue in the spinal canal to be pushed aside and protected before the interbody fusion device can be placed, which is complex, traumatic to the lumbar muscles and bone structure, and prone to nerve damage. The general minimally invasive technical solution is to go through a tiny skin incision, use a minimally invasive pull hook or expandable channel to pull the deep muscle tissue apart, and then expose the operative field with cold light-assisted illumination or endoscopy, only to shorten the skin incision, but the degree of muscle separation injury is no different from that of open surgery. After a long period of exploration, the He Erxing team of the Department of Spine Surgery at the First Hospital of Guangzhou Medical University has successfully treated many patients with lumbar spine disorders in the past six months using fully endoscopic posterior lumbar interbody fusion surgery, achieving very good results. This is another advancement in the team’s innovation in the field of minimally invasive lumbar fusion technology. The Department of Spine Surgery at the First Hospital of Guangzhou Medical University uses a small diameter closed tubular channel containing a small endoscope that exposes the spinal anatomy by separating very little muscle tissue. The new surgical protocol significantly reduces muscle damage, and the endoscope provides a clear surgical view without easily damaging nerves, making it a very safe and minimally invasive technique. Combining endoscopic posterior lumbar interbody fusion with another minimally invasive technique, percutaneous pedicle screw fixation, allows patients to achieve immediate post-surgical spinal stabilization, allowing them to get out of bed the first day after surgery and be discharged from the hospital in 3-5 days. The application of this technique reduces the cost of hospitalization, shortens the hospitalization period, saves blood, and increases the utilization rate of hospital beds. Full endoscopic posterior lumbar interbody fusion has been a technical challenge that fellow spine surgeons have tried to explore and solve. The minimally invasive technology research team of the Department of Spine Surgery at the First Hospital of Guangzhou Medical University redesigned the endoscopic tubular channel, the interbody fusion device used and the endoscopic surgical tools, and combined them with the previous experience of minimally invasive spine surgery accumulated for more than 10 years to figure out a safe and smooth surgical procedure, which is faster than conventional open surgery and can be carried out routinely and extensively, and belongs to the new minimally invasive replacement technology. Fully endoscopic lumbar fusion has obvious advantages compared with other current minimally invasive surgical approaches such as MIS-TLIF via the longest muscle gap access of the multifidus muscle and MIS-TLIF using expandable channels, and is a leap forward in minimally invasive lumbar fusion technology.