With the rapid development of minimally invasive lumbar spine surgery technology, minimally invasive surgical approaches are changing day by day. Different minimally invasive lumbar spine surgery methods can treat various lumbar spine disorders including lumbar disc herniation, lumbar spinal stenosis, lumbar degenerative slippage or isthmic cleft slippage, lumbar degenerative or idiopathic scoliosis, lumbar instability, lumbar infection, lumbar tuberculosis, tumors in the lumbar spinal canal, and other lumbar spine disorders. In other words, minimally invasive lumbar spine surgery can be used to treat almost all lumbar spine disorders. However, with the increase of minimally invasive surgery, patients with lumbar spine diseases are often confused by the following questions, which are also the most common questions we encounter when doctors visit outpatient clinics and consult online: 1. 2. Under what circumstances do I have to have surgery? 3.Is there any other good solution if I don’t have surgery? 4. Is lumbar spine surgery very dangerous? Is minimally invasive surgery more dangerous? 5.Can I have minimally invasive surgery if I have to have surgery? 6.What are the methods of minimally invasive surgery? What is the best minimally invasive treatment method I should choose? 7.What is the better efficacy of minimally invasive surgery compared to open surgery? 8. What is the cost of minimally invasive surgery? Okay, I will answer you all little by little along the above lines. 1. Can I not have surgery in my current condition? (1) If your symptoms, such as back pain, leg pain, lower limb numbness, urination and defecation, do not affect or mildly affect your normal work or life, and your doctor has done a physical examination and related X-ray or CT examination, and thinks that you do not need surgery at present, then conservative treatment can be done. (2) If your symptoms, such as back pain, leg pain, numbness in the lower extremities, urinary and fecal conditions, etc., mildly or moderately affect your normal work or life, and your doctor has done a physical examination and done the relevant X-ray or CT examination and thinks that the herniated disc is large or the spinal stenosis is very obvious, and surgery is recommended, you can choose surgery if conservative treatment is not effective. (3) If your symptoms, such as severe back and leg pain, numbness in the lower extremities, difficulty in passing stool or urine, etc., significantly affect your normal work or life, and the doctor has done a physical examination and related X-ray or CT examination, it is recommended that you choose surgery if the herniated disc is large or the spinal stenosis is very obvious. You can also consult with several spine surgeons. 2.When do I have to have surgery? Generally speaking, surgery is necessary when the symptoms are severe, such as pain that prevents you from walking 500 meters, numbness in the urinary and fecal areas, weakness and incontinence in the urinary and fecal areas, severe numbness in the lower extremities, inability to lift the back of the foot, etc., which seriously affects your work and life. 3.Is there any other good solution without surgery? The most common problem encountered in outpatient clinics, this question is best not to ask the doctor, huh. Because the premise of this question is that the doctor has recommended that you have surgery, the doctor must think that the best way is to do surgery, so ask this question is either afraid to do surgery, or do not trust the doctor in front of you. The best thing to do is to choose a few more professors in spine surgery and take another look. 4. Is lumbar spine surgery very dangerous? Is minimally invasive surgery more dangerous? Lumbar spine surgery is dangerous and requires caution, but it is not as dangerous as the people say, and the success rate is very high. If there is really a problem with one, we would have stopped doing it long ago without patients complaining. Personally, I think that if you choose a good doctor, the risk of lumbar spine surgery is similar to the risk of flying in an airplane, and there is not much chance of problems, but it is not impossible. Minimally invasive surgery, because of the small incision, must be followed by a small field of vision during surgery, so the doctor engaged in minimally invasive surgery must have a wealth of experience in open surgery; minimally invasive surgery must also have a microscope, magnifying glass, intraoperative X-ray fluoroscopy, special lighting and imaging equipment and other high-end equipment to ensure the safety of surgery; some minimally invasive surgery may need to be changed to open surgery, the hospital you visit must have these Some minimally invasive surgeries may need to be converted to open surgery. To sum up, it is recommended that you choose a tertiary care hospital that specializes in this specialty to ensure maximum surgical safety and efficacy. 5.Can I do minimally invasive surgery if I have to do it? Generally speaking, minimally invasive surgery is available for lumbar spine surgery, but each minimally invasive surgery has certain indications and contraindications, in other words, each patient needs a different minimally invasive treatment. This needs to be selected according to the disease condition, hospital conditions, doctor’s experience and ability. 6.What are the minimally invasive procedures? What minimally invasive treatment modality should I choose as the best? There are many minimally invasive surgical methods, I can only list some common minimally invasive surgical methods for your reference. (1) Percutaneous perforator nucleus pulposus chemolysis, percutaneous perforator discectomy, percutaneous laser vaporization disc ablation, percutaneous myeloplasty, percutaneous perforator ozone ablation. When you see so many names, you must be dizzy. In fact, the basic principle of all these surgical procedures is the same. Under X-ray fluoroscopy, the lumbar disc is punctured from the posterior or lateral posterior side (Figure 1) and the pressure within the disc is reduced or some of the disc tissue is removed using chemicals, laser, ozone, or low-temperature plasma ablation to achieve nerve root decompression. Indications and benefits: Patients with discography-confirmed young, inclusive disc herniation with relatively small herniation; or discogenic low back pain. The incision is the eye of the puncture needle and is therefore minimally invasive. Normal activity is possible almost immediately after surgery. Contraindications and disadvantages: The surgeon cannot operate under direct vision and cannot see the nerve tissue, so there is a greater possibility of nerve damage. The surgeon can only puncture and do disc fusion or disc removal under CT or X-ray fluoroscopy, making complete decompression difficult. It is not suitable for lumbar spine slippage, lumbar spinal stenosis, lumbar spine disc herniation is large, or the nucleus pulposus is prolapsed into the spinal canal, calcification of the intervertebral disc and posterior longitudinal ligament, and cauda equina syndrome with abnormal urination and defecation. The overall efficiency of surgery reported by foreign scholars is not high, but the surgical efficacy is acceptable based on strict selection of indications. (2) Intervertebral foraminoscopic disc removal (Figure 1): This procedure is based on the same disc puncture and discography as the previous one, with the addition of a surgical endoscopic system. The surgical incision is about 0.7 cm, and the surgeon can identify and remove the disc to release the compression under endoscopic surveillance; continuous saline flushing during the operation can remove toxic metabolites, painful and inflammatory mediators from the disc. With the gradual improvement of technology, endoscopic systems can now be inserted through the intervertebral foramen and the intervertebral plate space to perform disc removal. Indications and advantages: It is suitable for discogenic low back pain, simple disc herniation, no disc and posterior longitudinal ligament calcification. The lumbar vertebrae, paravertebral muscles and ligamentous tissues are hardly destroyed during the operation, with little bleeding and fast postoperative recovery. Contraindications and disadvantages: the operation is difficult and the learning time is long. Repeated X-ray fluoroscopy is required during surgery to make sure the puncture is correct. Narrow field of view, sometimes difficult to completely remove the herniated disc tissue. It is not suitable for lumbar spine slippage, lumbar instability, lumbar spine infection, tumor and deformity, disc and posterior longitudinal ligament calcification, and cauda equina syndrome with abnormal urination and defecation. (Figure 1a) Different percutaneous accesses for lumbar percutaneous disc surgery (3) Discoscopic disc removal: This procedure uses a traditional posterior approach to establish a working channel to the intervertebral space, removes the herniated disc tissue under microscopic endoscopy, and decompresses the ipsilateral lateral saphenous fossa and nerve root canal. Indications and advantages: suitable for patients with lumbar disc herniation and lumbar spinal stenosis. The advantage is that the spinal stability and lumbar muscles are further protected based on the traditional surgery. The visual field is wider than the previously described surgical approach, with a clear view and safe operation. The surgical incision is 2 cm. postoperative recovery is fast. Contraindications and disadvantages: The surgical technique is relatively demanding. Not suitable for lumbar spine slippage, lumbar instability, lumbar spine infection, tumor and deformity, disc and posterior longitudinal ligament calcification, and cauda equina syndrome with abnormal urination and defecation. (4) Minimally invasive interbody fusion The three methods described above cannot be used to treat lumbar spondylolisthesis, lumbar fractures, lumbar instability, lumbar infections, tumors and deformities. For such patients, minimally invasive percutaneous pedicle screw fixation and interbody implant fusion with vertebral canal decompression are currently available. The traditional posterior median approach used in traditional lumbar spine internal fixation surgery has disadvantages such as long incision, large injury and slow recovery, especially for multi-segmental lumbar spine surgery, extensive muscle stripping often leads to muscle atrophy and fibrosis, often resulting in postoperative lumbar weakness, pain and discomfort. Percutaneous nail placement can be achieved by placing pedicle screws within a 1-5 cm long incision with minimal damage, without stripping muscle tissue; minimally invasive access for spinal canal decompression results in a much smaller surgical incision than conventional surgical incisions (only about 3 cm for single-segment surgery), and the intermuscular approach eliminates the need for extensive stripping of muscle tissue; minimally invasive screws + minimally invasive surgical access The combination of both minimally invasive screw and minimally invasive surgical access techniques allows for spinal decompression, interbody bone grafting and lumbar fixation with minimal surgical trauma. This surgical approach is less invasive, less bleeding, less postoperative incision pain, faster recovery, and shorter hospital stay, and is extremely suitable for both young and elderly patients (Figures 3 and 4). (5) Minimally invasive lateral retroperitoneal fusion of the lumbar spine This surgical approach is a relatively new surgical approach that has emerged in recent years. Although it has certain surgical efficacy, there are certain risks associated with the surgery due to the large number of lateral nerves in the lumbar spine, and although the surgery was performed with the help of a neurological monitor, there were more complications of neurological damage in the early stages of the development of this surgical approach. With the continuous improvement of this surgical procedure in recent years, the safety has been gradually improved and the indications for surgery have been gradually broadened. The indications for surgery include: lumbar degenerative disc disease, lumbar spinal stenosis, lumbar degenerative scoliosis, congenital and idiopathic scoliosis, lumbar degenerative instability, posterior decompression-based assisted fusion, lumbar revision surgery (pseudarthrosis, ASD, etc.), lumbar disc replacement and its revision, thoracic disc herniation, thoracolumbar fracture, thoracolumbar infection, thoracolumbar tumor, etc. 7.What is better than open surgery in terms of efficacy of minimally invasive surgery? With the correct choice of minimally invasive surgery, the neurological decompression effect of minimally invasive surgery is the same as that of conventional surgery, but the overall efficacy is better than that of conventional surgery due to the advantages of small incision, less bleeding, less muscle damage and faster postoperative recovery. 8.What is the cost of minimally invasive surgery? The cost of minimally invasive surgery varies depending on the minimally invasive surgery method, so it is not quite the same.