Lumbar disc herniation is a series of symptoms and signs caused by disc degeneration, rupture of the annulus fibrosus and protrusion of the nucleus pulposus to compress or stimulate the nerve root or cauda equina at one or both sides of the corresponding level, and it is one of the most common orthopaedic diseases, with varying signs and symptoms and various classifications, and there are many problems in diagnosis and treatment. Due to the complexity of the etiology and pathology, there are non-surgical, minimally invasive and surgical treatments with large differences in efficacy. Combined with the clinical work of common types of lumbar disc herniation only on the choice of surgical methods to talk about their own experience, a total of reference. 1.Youth type In the teenage period, the intervertebral disc is less likely to degenerate, so the incidence of lumbar disc herniation in teenagers is relatively low, but the pathogenesis of the clinical manifestations of the disease is significantly different from that of adults, and then consider the protection of their future work and life and lumbar function, in the surgical method should not be used in the large incision fixation and fusion surgery, and small incision window nucleus pulposus removal surgery is often used to treat the disease, and the surgical process to minimize trauma, retain the vertebral plate, not destroy the joints, avoid extensive exploration, and avoid the need for surgery. The surgical process minimizes trauma, preserves the vertebral plate, does not destroy the joints, avoids extensive exploration, and takes the jelly-like nucleus pulposus as much as possible during the operation; in order to avoid postoperative recurrence, however, the operation still needs to strip the muscle behind the vertebral plate and part of the vertebral plate resection to enter the spinal canal, so as to pull open the dural sac and the nerve root to reveal the protruding disc tissues, which is prone to cause nerve injury and adhesion. The emergence of intervertebral foraminoscopy technology is a revolutionary change in the history of lumbar disc herniation treatment, for the disc herniation in adolescence; the minimally invasive treatment of intervertebral foraminoscopy technology has very obvious advantages: minimally invasive, no resection of spinal anatomical structures, no damage to spinal stability, no need for internal fixation, retention of spinal motor function, avoiding accelerated degeneration of adjacent segments caused by immobilization, which also means that it prolongs the normal use of spinal function time. It can prolong the normal use of spinal function; it has the advantages of less interference in the spinal canal, less nerve adhesion and faster recovery, etc. We have done a large number of cases and achieved very good results. 2.Olderly type The symptoms of lumbar intervertebral disc herniation in the elderly are atypical, the course of the disease is long, recurrent, often secondary to different degrees of lumbar spinal stenosis, and most of them are combined with underlying diseases, so that the open surgery is poorly tolerated or becomes a contraindication to give up the surgical treatment, so that the elderly people are suffering from the disease for a long time, which is very painful. Vertebral body slippage is often regarded as a manifestation of spinal instability and requires repositioning and fixation. The traditional approach is posterior approach laminectomy and decompression of the spinal canal, which is not only traumatic, bleeding and slow recovery, but also affects the stability of the lumbar spine. Elderly patients with degenerative vertebral body slippage, mostly manifested as nerve root compression symptoms, the disease duration is longer, lumbar symptoms are no longer obvious, the initial slippage instability manifestation of most of them have been self-stabilized, as long as the nerve root decompression can be achieved to decompress and release the therapeutic purpose. If the posterior open surgery, lumbar spine stability will be further damaged, the need for intervertebral fusion and transpedicular screw internal fixation, surgical trauma is more traumatic, often making both doctors and patients are afraid of the risk of giving up the surgery, and can not be treated. In recent years, with the deepening of the understanding of its pathological mechanisms and the advancement of technology, the concept of “precision spine surgery” has been put forward, and smaller invasive decompression surgeries have become a trend. Therefore, for older patients who are unable to tolerate surgery; for those who cannot accept open surgery for underlying diseases; for those who have no obvious unstable interspinous disc herniation or those who are combined with degenerative slippage by clinical assessment; intervertebral foramenoscopy technique can achieve the purpose of decompression and decompression of the compressed nerve roots under direct vision without destroying the stability of the spine, with less trauma, less bleeding, less complication, faster recovery, less pain, less cost, etc. It is safe and effective, and most of the patients can tolerate the procedure, It is safe and effective and can be tolerated by most patients. The author’s clinical application has achieved satisfactory results. Therefore, intervertebral foramenoscopy is an effective treatment method for elderly patients. 3.Multi-segmental type Multi-segmental lumbar intervertebral disc herniation has its clinical manifestations and signs of variability and complexity, which can be a single or multiple nerve compression clinical manifestations. The compressed nerves can be adjacent or spaced; they can occur unilaterally or bilaterally in different interspaces. It is often accompanied by stenosis of the spinal canal and lateral fossa, which is difficult to diagnose clinically, and a more accurate diagnosis can only be made by combining CT, MRI, CTM, X-ray film or vertebral angiography with symptoms and signs. Despite the complexity, the responsible segments can be found, therefore, the choice of surgical methods should be based on the lesion site and the number of segments to perform surgery with small and limited damage. Accurate judgment of the lesion segments and different forms of degeneration is the key to successful surgery. If the diagnosis is clear the intervertebral foraminoscopy technique is an effective method that can be chosen, with the advantages of small trauma, fast recovery, safety and reliability, and low cost. If there are multi-segmental lesions or instability, open decompression and fixation and fusion are needed, which is generally rare. Moreover, percutaneous fixation has been successfully carried out at the same time of minimally invasive decompression in the intervertebral foramenoscopy, which significantly improves the effect of minimally invasive treatment, and the scope of application is constantly expanding. Extremely lateral type Extremely lateral type lumbar disc herniation means that the herniated disc is located outside the arch root margin, and its symptoms, signs, and treatments are different from the common posterior lateral herniation. This type is the earliest, easiest to accomplish, and most effective type of lesion for which intervertebral foraminoscopic techniques have been applied. The traditional approach is to use transpedicular posterior median approach with plate enlargement and opening, foraminotomy and pedicle screw internal fixation with implant fusion or myelomeningocele approach with nucleus pulposus removal, respectively. Extremely lateral type is easy to be misdiagnosed or missed, and is a common type of lumbar disc herniation with poor postoperative results. Rupture type According to the International Society for the Study of the Lumbar Spine (issls) classification, posterior longitudinal ligament subluxation, posterior longitudinal ligament posterior subluxation and free type are rupture type herniation. Once diagnosed, surgery should be performed as early as possible, usually choosing the traditional classic interlaminar opening or hemilaminectomy, to fully expose the free nucleus pulposus in the intervertebral space and spinal canal. The mass of nucleus pulposus tissue is removed, and then the rupture is searched for along the nerve root, and all the intervertebral disc tissue and nucleus pulposus in the intervertebral space around the rupture are removed. This is the type of lesion that can be easily accomplished with minimally invasive intervertebral foraminoscopic techniques without causing damage to spinal structures and should be selected. However, if the nucleus pulposus is free to the posterior aspect of the dural sac, posterior approach surgery is required. Calcified type Calcified lumbar disc herniation refers to the necrosis of the prolapsed intervertebral disc tissue, calcium salt deposits into bony nodules, which is irreversible disc herniation. Once diagnosed, surgical treatment should be preferred. The surgical method is based on the patient’s age and the presence or absence of spinal stenosis, and adopts half or total laminectomy. During the operation, it is necessary to carefully separate and fully loosen the adhesion before pulling the nerve root, and the removal of sclerotic tissues is preferable to a one-time removal by ring drilling, and a small bone chisel can also be used for ring chiseling, flattening the surrounding bony cumbersome and then removing the deep-surface nucleus pulposus tissues. In recent years, with the development of microscopic instruments, this type has been satisfactorily treated with intervertebral foramenoscopic technique, which has been used in a large number of clinical cases. 7. Patients with lumbar disc herniation are often combined with spinal stenosis, especially lateral fossa stenosis. It is very important to determine whether there is spinal stenosis or not in order to decide the surgical method; if the nucleus pulposus is removed alone without enlarging the stenosed lateral fossa, there will be the risk of paraplegia after surgery. The surgical approach should be ① half laminectomy limited decompression nucleus pulposus removal, lateral socket enlargement, nerve root release. Posterior total laminectomy with adequate decompression, lateral fossa enlargement, nucleus pulposus removal, and intervertebral bone grafting. ③ In recent years, with the development of microscopic instruments, this type has also been satisfactorily treated with intervertebral foramenoscopic techniques, and there have been a large number of clinical applications. 8, combined with the cauda equina compression type This type of patients in addition to the signs of disc herniation, there are double lower extremity sensory impairment, muscle weakness, urinary and fecal dysfunction. This type of herniated disc is mainly of central type or “dead bone” type, and should be operated as early as possible to relieve the compression, in order to prevent irreversible damage caused by neurodegeneration. It is appropriate to use total laminectomy to remove the protruding intervertebral disc, in addition to removing the protruding intervertebral disc during the operation, but also pay attention to the intervertebral plate and the yellow ligament at the beginning of the superior sublaminar plate to get the complete decompression of the soft tissue components of the vertebral canal and loosening, in recent years, with the development of microscope operation equipment, this type of laminar foraminoscopy has been satisfied with the treatment of the technology, and the clinic can choose to apply. 9.Combined with lumbar instability type, lumbar disc herniation is often combined with lumbar instability or slipping, preoperative x-ray must include positive and lateral position, hyperextension and hyperflexion position, if the angle of adjacent intervertebral space is more than 15° or intervertebral displacement is more than 3mm that is to diagnose the lumbar instability or slipping, the surgical method should be used for total discectomy, expansion of the lateral saphenous fossa, nucleus pulposus removal, bone grafting in intervertebral space or transverse process plus pedicle internal fixation so that the disc herniation can be treated and fixed at the same time. In this way, the lumbar spine is fixed at the same time of dealing with the herniated disc, which can avoid the secondary surgery due to lumbar instability and reduce the pain of patients. However, in recent years, there have been a large number of reports of minimally invasive fixation and fusion, which will certainly become the future development trend. 10, recurrent lumbar disc herniation refers to the lumbar discectomy of the same section of the same side or the opposite side of the disc tissue again protrudes and compresses the nerve root. Postoperative recurrence is the main reason for reoperation of disc herniation, and the recurrence rate is 5% to 11%. The traditional treatment is still based on the classic posterior laminectomy and decompression nucleus pulposus removal, but due to the local anatomical changes caused by the initial surgery and the different degrees of fibrous scar adhesion inside and outside the spinal canal, the lumbar disc revision surgery not only has a high level of surgical complications; such as dural tear and nerve root injury, as well as spinal instability due to the breakthrough of the small joints, but also has a high level of difficulty in the surgical operation. There is also a high risk of nerve root and cauda equina injury. In order to increase the safety rate and reduce the difficulty of surgery, adequate anatomical exposure, extensive soft tissue dissection, and access from the unoperated intervertebral space of the neighboring segments are the most common surgical approaches for lumbar disc revision. Expanded decompression often results in further destabilization of the spine, requiring concomitant intervertebral bone grafting plus internal fixation and fusion, with long operative time, excessive bleeding, high risk, and many complications, which have been learned from many lessons. Although minimally invasive lumbar disc revision with posterior METRx has been successfully reported, it is still very difficult to perform because of the need to enter through the original incision, and there are certain challenges and limitations. The METRx technique with lateral foraminal access avoids the formation of scar tissue posterior to the initial procedure and reduces the risk of dural sac tear and nerve injury. The working channel is obtained through a reaming drill, which allows direct removal of herniated discs and other compressed nerve tissue without disturbing the scar tissue, achieving decompression under direct vision. Intraoperative observation of the nerve pulsation in line with the heartbeat is a sign of adequate decompression of the nerve. All recurrent lumbar disc herniations in our hospital were treated by intervertebral foramenoscopy technology with satisfactory results and no complications, which has very obvious advantages compared with posterior open surgery and posterior laminectomy. In conclusion, most of the lumbar disc herniations can be treated minimally invasively by intervertebral foramenoscopy technology, which is less traumatic, quicker recovery, safer and more reliable, with better efficacy and lower cost, and will surely become the trend of future development.