The most effective and reliable method for the treatment of lumbar disc herniation is disc nucleus pulposus removal and nerve root channel cleaning. It has been the direction of spinal surgery to reduce trauma, maintain spinal stability and reduce postoperative complications on the basis of ensuring surgical results. Since 1995, the Department of Orthopedic Surgery of Jieyang People’s Hospital has been performing posterior small incision disc removal under local anesthesia to remove the nucleus pulposus and clean up the nerve root channel, and has achieved very satisfactory results. This procedure is suitable for patients with recurrent single-segment and adjacent double-segment lumbar disc herniation, or patients with concurrent lateral saphenous fossa stenosis in the same segment for whom systematic conservative treatment or percutaneous aspiration, chemical nucleolysis and other treatments have failed. Advantages of this procedure: (1) Biomechanical studies of the spine have shown that the lower lumbar segment is the site of greatest weight-bearing and activity shear of the trunk, and the posterior column structure in the spine is important for maintaining the stability of the spine. Traditional laminectomy destroys the posterior and even the middle column structures, and postoperative instability or even slippage of the lumbar spine is likely to occur. The incision length is only 3.0 cm, and the paravertebral muscles are not extensively peeled off, and only a small amount of the lower edge of the lamina is bitten off to enlarge the lamina space. (2) This procedure all adopts local anesthesia, making full use of the local anatomical characteristics of the posterior branch of the lumbar nerve crossing from the posterior side of the transverse process of the vertebral plate, which is safe, economical and effective, and reduces the pain and risk of epidural puncture borne by patients undergoing traditional epidural anesthesia, while the effect of traditional continuous epidural anesthesia is basically lost after opening the spinal canal, and local anesthesia can also correctly locate the affected nerve root according to what is seen intraoperatively and the patient’s awake sensory condition. The nerve roots involved can be correctly located and the herniated nucleus pulposus missed by clinical and X-ray examination can be found, so that the nerve roots can be avoided by mistake. In addition, the local anesthetic solution was injected with a mixture of procaine and lidocaine to make a synergistic effect, which reduced the dosage of two drugs and alleviated the toxic reactions and adverse reactions of drug absorption, and the addition of a small amount of epinephrine could reduce blood leakage from the trauma after local tissue incision and keep the surgical field clear. The efficacy was excellent according to Nakai grading, with complete disappearance of signs and symptoms and return to original work.