According to Lee’s classification of displaced disc herniations, those above the inferior border of the superior pedicle are classified as Very High cephalad displacement, and those below the inferior border of the inferior pedicle are classified as Very High caudal displacement. Surgical treatment of highly (High) and very highly (Very High) displaced disc herniations is a challenge for foraminoscopic techniques. This study discusses the treatment strategy and follow-up results for displaced disc herniations. When a foraminal approach is chosen for the treatment of highly displaced disc herniation, we use a two-needle technique, with one needle punctured into the disc for imaging and Melan staining of the prolapsed and displaced nucleus pulposus, and the other puncture needle directed toward the direction of the disc herniation for target puncture, enlargement of the foramen, and placement of a working trocar near the displaced nucleus pulposus in the spinal canal. For mild and highly cephalad and caudal displaced disc herniations we used a foraminoscopic approach, for a very highly cephalad displaced disc herniation we used a foraminoscopic approach, and for a very highly caudally displaced disc herniation with cauda equina syndrome we used combined foraminoscopic and interlaminar surgical treatment. The patients were evaluated for preoperative and postoperative leg pain VAS scores and Oswestry dysfunction index. Twenty patients were followed up for 6 months after surgery, and none underwent reoperation for reherniation or residual nucleus pulposus. The postoperative VAS score for low back and leg pain was 0-2, and the postoperative Oswestry dysfunction index decreased from 68% preoperatively to 10.3% postoperatively. 89.2% of the patients had an excellent Macnab evaluation. For displaced disc herniation, the correct treatment strategy is used depending on the direction and degree of herniation, and for very highly displaced disc herniation, a combination of foraminal approach or interlaminar approach can yield good results.