Low back pain is common in China, and there are few adults who have not suffered from low back pain. Some people come to the hospital with severe low back pain or with radiating pain in the lower extremities, and after a series of examinations, it is found that the lumbar disc herniation is huge and needs surgery, and then they face the problem of choosing the surgery method: open surgery? Discoscopic surgery? Intervertebral foraminoscopy? What is the difference between them? To figure out the difference between them, you need to know how the respective surgery is done. Open surgery refers to a 3-5 cm skin incision at the back of the back, followed by a deep incision of the back muscles to reveal the vertebral plate, and then a small window with a special instrument to bite the plate, enter the nerve, reveal the protruding disc below, and then remove the disc, and finally suture the tissue layer by layer to end the surgery. The entire procedure is performed under continuous epidural anesthesia (hemi-anesthesia) or general anesthesia. ▪ Discoscopic surgery Discoscopic surgery is actually a scaled-down version of open surgery. ■ Intervertebral foraminoscopy There are two approaches to foraminoscopy, one from the lateral side of the back and one, like discoscopy, from the posterior side of the back. Regardless of the approach, the disc is accessed directly by puncture, and the working canal is established by gradual expansion. Through this working canal, which is 0.6 cm in diameter, the herniated disc tissue is removed. Expert Analysis My understanding of the above three surgical procedures is as follows: 1. Open surgery can basically be replaced by discoscopic surgery. Because the two principles are the same, and the latter is less traumatic. 2. If you can choose foraminoscopic surgery, you should not choose discoscopic surgery. Because the damage of foraminoscopic surgery is much less than discoscopic surgery, many patients’ pain disappears immediately after surgery and they can walk on the ground immediately, which means that there is very little disturbance to the body, and the other two surgeries cannot achieve such effect. 3. Not every patient with disc herniation can undergo foraminoplasty, and some patients with long herniation and significant narrowing of the intervertebral space and foramina are not suitable. The specific situation needs to be judged by the doctor. 4. Open surgery and discoscopic surgery can remove part of the disc that has not yet herniated, which reduces the probability of disc reherniation. The best choice The foraminoscopic technique, also known as percutaneous foraminoscopy-assisted lumbar discectomy, was developed on the basis of percutaneous automatic discotomy and aspiration. It is currently the most minimally invasive, safe and economical technique, and its technical advantages are as follows: (1) Minimally invasive Reaching the target area through a lateral approach, avoiding interference with the spinal canal and nerves by traditional posterior surgery, without biting off the lamina, without destroying the paravertebral muscles and ligaments, and without affecting the stability of the spine. (2) Direct Direct removal of the herniated disc and clear surgical decompression. (3) Wide indications Can deal with most of the herniated discs, some of the spinal stenosis, foraminal stenosis and other lesions. With the use of special radiofrequency electrodes under the scope, fibrous annuloplasty and annular nerve branch blockage are feasible to treat discogenic pain. (4) Low complications Low trauma, low chance of thrombosis and infection formation; no postoperative scarring at important posterior structures causing adhesions to the spinal canal and nerves. (5) High safety Local anesthesia, which can interact with the patient during the operation without injuring the nerves and blood vessels; basically no bleeding and clear surgical field, which greatly reduces the risk of misoperation. (6) Quick recovery The next day after surgery, the patient can go down to the floor and resume normal work and physical exercise in 3-6 weeks on average. (7) High patient satisfaction Immediate pain relief, self-care of urination and defecation, simple care, oral antibiotics can be taken, and the skin incision is only 7mm, in line with the aesthetic point of view. (8) Wide range of extension Combined with percutaneous fixation technology, the fusion and fixation of spinal slippage and instability can be completed using a minimally invasive approach; this basic platform can be easily extended to cervical disc endoscopic surgery.