Minimally invasive spine techniques have evolved rapidly in response to changes in the medical paradigm, advances in medical technology, and the growing philosophy of minimally invasive clinicians. Since Smith’s innovative report on chemical nucleolysis in 1963, minimally invasive spine techniques have evolved from blinded percutaneous techniques, such as chemical nucleolysis, laser and radiofrequency physical ablation, and percutaneous mechanical discectomy; to microdiscectomy; to endoscopic-assisted minimally invasive spine surgery, such as arthroscopic-assisted discectomy, microendoscopic-assisted discectomy, thoracoscopic and laparoscopic-assisted discectomy, and other procedures. The YESS technique was first used and proposed in 1998 by Dr. Anthony Yeung, Chairman of Minimally Invasive Medicine in the United States, on the basis of percutaneous discectomy and aspiration, marking the birth of percutaneous laminectomy technique. However, its indications are narrow and it is difficult to effectively deal with prolapsed and free disc tissue; it is even more difficult to effectively deal with central canal and lateral saphenous stenosis; it is also extremely difficult to deal with patients with lumbar 5 sacral 1 disc herniation who have higher iliac spine and foraminal stenosis. In 2002, Professor Hoogland of Germany proposed the THESS technique on the basis of the YESS technique. He designed a set of intervertebral foramen reamers of different diameters to remove part of the bony structure of the anterior and inferior edges of the superior articular eminence step by step, enlarge the intervertebral foramen, and enter the spinal canal directly through the enlarged foramen, which can remove the prolapsed and free disc under the direct view of the endoscopic system. It can also effectively manage lumbar disc herniation with foraminal stenosis. Thus, the advent of percutaneous transvertebral foraminal spine endoscopy has revolutionized the minimally invasive treatment of lumbar spinal canal disc herniation and allows for the treatment of almost all types of lumbar disc herniation. However, there are still many difficulties and problems for the treatment of spinal stenosis that need to be studied and solved by minimally invasive spine physicians, especially for central spinal stenosis. In clinical practice, we found through literature review and study of nerve root canal anatomy that central spinal stenosis at the same interspace level can be decompressed through a percutaneous spinal endoscopic transvertebral foraminal approach, which was confirmed by clinical practice to achieve satisfactory treatment results and was first reported in China. We have made the endoscopic transvertebral foraminal approach to degenerative lumbar spinal stenosis the goal of our study, to further explore and expand the indications for the procedure, and to propose new methods and theoretical guidance for minimally invasive spine surgeons in the treatment of spinal stenosis by endoscopic transvertebral foraminal approach, and to enable effective treatment of some elderly patients and patients with multiple underlying diseases who cannot tolerate open surgery. Lumbar spinal stenosis is a disease in which the central spinal canal, lateral saphenous fossa, or intervertebral foramen of the lumbar spine is narrowed, causing compression of the lumbosacral nerve roots and cauda equina nerves, resulting in intermittent claudication and sciatica as the main symptoms, and as a common spinal disease with a high prevalence in middle-aged and elderly people. Lumbar spinal stenosis not only affects the quality of daily life of patients, but also imposes a serious burden on their families and society. The disease often requires surgery when conservative treatment is ineffective or aggravated. The traditional decompression and fixation surgical method is physiologically devastating to the patient, destroying the normal anatomy of the spine and causing a decrease in spinal stability, often requiring internal fixation combined with vertebral fusion, which in turn accelerates the degeneration of the adjacent segments to form a vicious circle. At the same time, elderly patients are often combined with underlying diseases, difficult to tolerate such surgery or general anesthesia and give up treatment, in addition to taking traditional surgical treatment, the hospital stay before and after surgery is long, the cost of treatment is high, bringing a certain economic burden to the patient’s family and society. With the improvement of percutaneous transvertebral endoscopic decompression technology and medical equipment, endoscopic surgical treatment of lumbar spinal stenosis has gradually become possible. Compared with conventional surgery, percutaneous transvertebral endoscopic minimally invasive decompression technology has the advantages of small surgical incision, less injury, less bleeding, effective protection of spinal stability, low complication rate, low overall impact on the patient, good patient tolerance, safety and reliability, and short hospitalization time.