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, it is necessary to know how the respective surgery is done. Open surgery Open surgery involves making a 3-5 cm skin incision in the back at the appropriate surgical site, then cutting deep into the back muscles to reveal the vertebral plate, then biting a small window into the plate with a special instrument to distract the nerve and reveal the herniated disc below, then removing the disc, and finally suturing the tissue layer by layer to end the surgery. The entire procedure is performed under continuous epidural anesthesia (hemianesthesia) or general anesthesia. Discoscopic surgery Discoscopic surgery is actually a scaled-down version of open surgery. Foraminoscopic surgery There are two approaches to foraminoscopic surgery, one from the lateral side of the back and one, like discoscopic surgery, from the posterior side of the back. Regardless of the approach, the disc is accessed directly by puncture and the working canal is created after grade-by-grade expansion. Through this working canal, which is 0.6 cm in diameter, the herniated disc tissue is removed. Expert analysis For the above three surgical methods, my understanding 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 interference with the human body, and the other two types of surgery cannot achieve such an effect. 3. Not every patient with disc herniation can undergo foraminoscopic surgery, and some patients with long herniation time and significant narrowing of the intervertebral space and foramen 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 with the following technical advantages: (1) Minimally invasive to reach the target area through a lateral approach, avoiding interference with the spinal canal and nerves by traditional posterior surgery, without biting off the vertebral plate, without destroying the paravertebral muscles and ligaments, and with no effect on spinal stability. (2) Direct removal of the herniated intervertebral disc and clear surgical decompression. (3) Wide indications can deal with most of the herniated discs, part 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 forming thrombosis and infection; 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, does not hurt the nerves and blood vessels; basically no bleeding, clear surgical field, greatly reducing the risk of misoperation. (6) Fast recovery The next day after surgery, you can go down to the ground and resume normal work and physical exercise in 3-6 weeks on average. (7) High patient satisfaction Immediate pain relief, self-care of urine and stool, simple care, oral antibiotics can be taken, and the skin incision is only 7mm, which is in line with the aesthetic point of view. (8)Extensive 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.