What is minimally invasive lumbar spine foraminoscopy? Percutaneous foraminoscopic lumbar disc herniation nucleus pulposus removal is mainly used for discogenic lower back pain, lumbar disc herniation and lumbar spinal stenosis. Although minimally invasive lumbar foraminoscopic surgery has the advantages of less trauma, less intraoperative nerve interference, unaffected spinal stability and faster postoperative recovery, the removal of limited lesions in the deep, cauda equina and nerve root vicinity of the lumbar region via tiny skin incisions (7-10 mm) and relatively dangerous areas requires surgical techniques and clinical concepts with precise endoscopic regional localization of treatment. With the continuous development of spinal endoscopic technology concepts and surgical instrumentation, foraminoscopic techniques have revolutionized the treatment of a wide range of lumbar degenerative diseases including all types of LDH, discogenic low back pain and lumbar spinal stenosis, from the initial use of inclusive disc herniation as the only indication for endoscopic surgery. The key to foraminoscopic operation is precise positioning and puncture, and the patient’s symptoms and signs, such as the nature and location of pain, are the main basis for determining the site of herniation and pressure, while imaging has important reference value. Based on the actual operation and imaging characteristics of intervertebral foraminoscopy, we combine the regional localization and typing of lumbar disc herniation, determine the site of disc herniation, and then adopt the concept of intervertebral foraminoscopy with different approaches to the herniated target to ensure that the working trocar can precisely reach the target of the herniated disc and easily remove the herniated disc nucleus pulposus and other pressure-causing tissues. YESS and TESSYS techniques Currently, the most commonly used foraminoscopic techniques include the YESS technique and the TESSYS technique, both of which are lumbar posterolateral transforaminal puncture techniques, but differ in terms of surgical concept, puncture technique, and placement of the working trocar. The TESSYS technique is indicated for LDH with intra-vertebral canal protrusion and special types of LDH with foraminal stenosis, which requires partial removal of the bony structures at the anterior and inferior edges of the superior articular process and expansion of the working channel to effectively reveal the target site of the protrusion. The nerve roots and the dural sac in the spinal canal are visible after decompression. There are also improved methods such as extreme lateral percutaneous puncture, posterior median approach to the lamina cribrosa, and direct placement of the working trocar into the spinal canal through the enlarged foramina, where the disc tissue is removed directly under direct vision through the anterior dural space. Application The application of this technique firstly ensures an adequate surgical view and exact decompression of the spinal canal, and at the same time avoids the possibility of biting off the vertebral plate and too much bone in the small joints due to simple open surgery, which may even affect the stability of the spine, plus the endoscopic intravertebral canal operation image magnification and more delicate and safe operation. For special types of LDH, such as combined with huge bone spurs at the posterior edge of the vertebral body or cartilage endplate rupture, it is recommended to determine the responsible site of herniated compression according to clinical symptoms and signs, select the target site of pressure-causing treatment, and perform limited decompression through the posterior lateral or interlaminar approach, with the main purpose of relieving the compression of nerve roots or dural sac. The bone block at the posterior edge of the vertebral body is generally fixed in position, and decompression at the target site can relieve the symptoms of back and leg pain without worrying about the residual protrusion free displacement or re-pressurization, while forcible removal of all the bone blocks is highly traumatic and prone to complications, which often outweighs the losses. In conclusion, various surgical techniques have different characteristics and indications, following the concept of regional localization of pressure-causing sites, precise puncture, and minimally invasive treatment, and choosing the appropriate surgical method according to the type of LDH and the protrusion site, in order to exchange the smallest possible surgical trauma for satisfactory recovery of nerve function. Rational selection of surgical indications and the development of a practical endoscopic surgical plan can ensure the effectiveness of LDH treatment.