A 50-year-old patient was admitted to the hospital for 15 days with numbness, pain and weakness in the right lower extremity. 15 days ago, he suddenly developed numbness and weakness in the right lower leg with tingling sensation, which was aggravated by walking, and was seen at a local hospital for lumbar spine CT. The right knee tendon reflex disappeared, suggesting that there should be a problem with the L4 or L5 nerve root. Further review of the MRI of the lumbar spine showed a herniated nucleus pulposus at the right intervertebral foramen of the L4/5 segment compressing the right L4 nerve root. The patient’s medical history, symptoms, signs and imaging examinations were combined, and the diagnosis was clear. There are several surgical options: 1, percutaneous laminectomy with percutaneous foraminoscopy, advantages: local anesthesia, no need to eat, poor comorbidities, 10 times magnification of the field of view, early postoperative activities, incision of only 8 mm, etc., disadvantages: long learning curve, blind area in the field of view in some cases; 2, lumbar posterior Quadrant channel with interlaminar window for nucleus pulposus removal, advantages: surgery under direct vision, convenient operation 3, posterior lumbar laminectomy with decompression and internal fixation, advantages: very low or no recurrence rate, early postoperative landing, fast return to work, etc., disadvantages: use of internal fixation, loss of lumbar motion segments, degeneration of adjacent segments, etc. The patient was admitted to the operating room at 2:00 p.m. in the prone position, keeping the body parallel to the bed, and the G-arm was positioned accurately, showing a standard lumbar frontal and lateral radiograph with the L4/5 intervertebral space and articular eminence joints intact, and the body puncture point was marked. The point was routinely disinfected, sterile towel sheet was laid, 1% lidocaine was used for local anesthesia of about 5 ml, and the 18G puncture needle was used to puncture the tip of the right superior articular eminence of L5 along the marker line, and the patient felt slight pain, which disappeared after the administration of local anesthetic drugs. G-arm fluoroscopy in both front and side position at the tip, pointing to the upper level of the L4/5 disc, gently lift the tail of the puncture needle, slide it over the tip and reach the posterior edge of the vertebral body, place the guidewire, fluoroscopy position is ideal, place the 1-3 level catheter step by step, work the cannula directly into the intervertebral foramen, 22G puncture needle into the intervertebral disc to hit the Melan stain the whole process patient no discomfort, connect the monitor, lens, saline, etc., adjust the white balance, the field of view is seen Stained protruding nucleus pulposus tissue, carefully removed several free nucleus pulposus until the right L4 nerve root was revealed, let the patient move the right lower extremity, visible nerve root mobility restored, further treatment of the intra-disc and marginal fibrous annulus, the operation was completed, bleeding about 5 ml, the patient had no significant pain without analgesic drugs, time about 1 hour and 10 minutes, back to the ward 6 hours after with lumbar circumference down.