Hult estimates that as many as 80 percent of people suffer from low back pain at some point in their lives. The National Center for Health Statistics reports that injuries to the spine and low back are the most common cause of activity limitation in people under the age of 45. Lumbar spine disorders are common and prevalent and have a significant impact on people’s work and life, and they can be very difficult to treat. It is now the case that sciatica has become a household name in the spine patient population and lumbar discectomy is one of the most performed procedures in the world. Lumbar disc herniation (LDH) is the most common cause of low back pain. For patients who require surgery, traditional open surgery is highly invasive and has an impact on spinal stability. With the development of minimally invasive concepts and techniques, minimally invasive approaches continue to emerge. The essence of minimally invasive is that it should be similar in efficacy to traditional surgery, yet maintain the maximum amount of spinal structure, striking a balance between decompression and reduction of damage. It is currently the most desirable minimally invasive treatment method that can fundamentally solve the problem of herniated discs without affecting the functional structure of the spine, with minimal trauma and quick recovery. The percutaneous endoscopic nucleus pulposus removal technique (intervertebral foraminoscopy technique) meets this requirement. In 1997, Yeung et al. developed the third-generation spinal endoscopic YESS system ( Yeung Endoscopy Spine System ), marking the gradual maturation of this minimally invasive technique. With the continuous improvement and development of spinal endoscopic techniques and surgical instruments, as well as the clinical application of advanced surgical equipment such as lasers, radiofrequency, surgical navigation and surgical robotic systems, percutaneous foraminoscopic techniques have been revolutionized. From the blind postero-lateral percutaneous lumbar disc resection in the early stage to the direct resection under direct endoscopic view today, from the indirect disc decompression through the Kambin safety triangle into the disc in the past to the direct removal of free disc tissue and release of adherent nerve roots through the intervertebral foramen approach today, from the simple inclusive lumbar disc herniation in the past to the ability to perform various types of The procedure has become the most promising and minimally invasive endoscopic technique of the spine today, as it can only remove discs, prolapsed discs and free tissue masses, and perform percutaneous foraminal enlargement for foraminal stenosis. In recent years, with the rapid development of percutaneous foraminoscopy (PELD) technology in China, this is one of the earliest minimally invasive spine surgery endoscopic techniques, and is also a new technology that is rejuvenating. This technology is a true spinal endoscopic system, which operates under direct vision and can clearly and completely remove protruding tissues or prolapsed nucleus pulposus, remove osteophytes, treat spinal stenosis, and at the same time, the equipment is equipped with a radiofrequency tip, which can repair the broken fibrous ring with radiofrequency technology in the operation field; without cutting deep tissues, without damaging the muscles, ligaments and bony structures around the spine, which can protect the spine to the greatest extent. Stability; less trauma, faster recovery, and higher safety. Similar to a spinal endoscope, an intervertebral foramoscope is a lighted tube that enters the intervertebral foramen from the side or back of the patient (either in a flat or oblique manner) and performs the procedure in a safe working triangle. The procedure is performed outside the disc’s fibrous annulus, and the herniated nucleus pulposus, nerve roots, dural sac and hyperplastic bone tissue can be clearly seen under direct endoscopic vision. The herniated tissue is then removed using various types of grasping forceps, the bone is removed microscopically, and the broken fibrous annulus is repaired with radiofrequency electrodes. The surgical trauma is small: the skin incision is only 6mm, just like the size of a soybean grain, bleeding is less than 20ml, and only 1 stitch after surgery. It is the least traumatic and most effective minimally invasive treatment for disc herniation among similar surgeries. Intervertebral foraminoscopy removes the herniated or prolapsed nucleus pulposus and proliferating bone outside the foramen’s safe triangle and the disc’s fibrous ring to relieve pressure on nerve roots and eliminate pain caused by nerve compression. While completely removing the herniated or prolapsed nucleus pulposus, it removes osteophytes, treats spinal stenosis, and can repair the broken annulus fibrosus using radiofrequency technology. A: For simple disc herniation and partial prolapse type cases, the posterior lateral safety triangle approach is preferred. B:The distal lateral horizontal approach is suitable for central giant herniation. C:Posterior or interlaminar approach for free or calcified type patients The key to the efficacy of minimally invasive treatment is to select the indication, identify the problem disc, and select the most appropriate minimally invasive approach. The selection criteria for foraminotomy or endoscopic microdiscectomy are not fundamentally different from those for laminectomy and disc removal. Patients with herniated discs selected for minimally invasive surgery must exhibit signs and symptoms of nerve root compression, with the following indications and contraindications: Indications Persistent or recurrent radicular pain (leg pain), or at least radicular pain heavier than low back pain. Failure to respond to strictly conservative treatment. Including the use of steroidal or non-steroidal anti-inflammatory analgesics, physiotherapy, and occupational or conditioned training procedures, conservative treatment is recommended for at least 4-6 weeks, but immediate surgery is required if there is a progressive worsening of neurological symptoms; a positive straight leg raise test; contraindications Those with underlying medical conditions, such as heart disease, epilepsy, or other risks that potentially require a change to intravenous or general anesthesia; those with more contagious diseases, with outpatient sterilization and Children younger than 14 years of age; adults older than 80 years of age; patients with spinal instability requiring endoprosthesis or other orthopedic needs for internal fixation Clinical advantages of foraminoscopy Percutaneous foraminoscopy (successful removal of the nucleus pulposus in many patients with lumbar disc herniation). The patients were all suffering from lumbar pain and unilateral lower limb radiating pain, which was ineffective after medication and bed rest, and seriously affected their work and life. After thorough preparation, the patients’ pain was relieved immediately by completing the microscopic disc nucleus pulposus removal under local anesthesia via the lateral lumbar approach. After the operation, the symptoms were relieved as normal, and the patient could be discharged from the hospital one minute after the operation. It is understood that this technique removes herniated disc tissue under endoscopic surveillance through a special lateral intervertebral foramen approach, which is less invasive than the usual posterior approach. A typical laminectomy, in order to approach the target point, necessarily causes extensive damage to structures that play an important role in spinal stability, which usually requires immediate spinal fusion. In contrast, the laminectomy technique gradually enlarges the intervertebral foramen with a patented reamer and appropriate medical instrumentation, completely removing any herniated or prolapsed fragments as well as the degenerated inflamed nucleus pulposus. It also provides continuous irrigation of the lesion to reduce inflammation, uses radiofrequency electrodes to repair the annulus fibrosus, ablates nerve sensitizing tissue, blocks the annular nerve branches, and relieves the patient of soft tissue pain. Foraminoscopy versus other treatments The greatest advantage of foraminoscopy is its access. It is entered through the natural anatomical access (intervertebral foramen) from the nerve roots and the dura mater underneath the most article. It has a unique advantage over posterior surgery. This technique has had an inherent advantage since its inception. An additional advantage is the direct vision technique. Not only does it improve safety, but compared to indirect decompression techniques such as mechanical nucleus pulposus excision and decompression, chemical nucleolysis or laser vaporization, foraminoscopic disc removal is a direct technique for targeted removal of herniated disc fragments and decompression of nerve roots. Although the posterior discoscopic technique (MED), which has been widely recognized in recent years, can be applied to all types of lumbar disc herniation, its minimally invasive nature is limited because its surgical approach and procedure are the same as that of small-incision open surgery, which requires a paravertebral muscle approach and implementation of a laminar opening, and removal of muscle ligaments and bony structures. Foraminoscopic techniques have the distinct advantages of less trauma, less bleeding, easier anesthesia, faster postoperative recovery and less financial burden. Summary of the advantages of intervertebral foraminoscopy: (1) Less traumatic surgery: Compared with conventional open surgery, minimally invasive spine surgery has smaller incisions and significantly less damage to the paravertebral muscles. (2) Satisfactory efficacy: for suitable patients, the efficacy is higher than that of open surgery, with an excellent rate of over 85%. (3) Quick recovery, with 1 minute to get off the floor after doing so. (4) Surgical bleeding is very low and can be considered negligible. (5) Small skin incision (6 mm), more aesthetic. (6) You can get off the ground in 1 minute after the operation and be discharged on the same day, and the hospital stay is only a few hours. (7) Easier to remedy in case of disease recurrence and reoccurrence, and even to remedy the problems of open surgery. This technique represents a new concept of minimally invasive spine surgery and is a breakthrough development in the treatment of disc herniation. Because of its many superiorities, it is now recognized in the international field of spinal surgery that foraminotomy will dominate this field.