The technique of anterior cervical open disc surgery for cervical disc herniation has become very mature and has also received better clinical results. However, due to many factors such as surgical risk, efficacy, and economic ratio. However, the clinical study on the treatment of cervical disc herniation by total endoscopic trans-anterior cervical discectomy has not been reported. Methods: 1. General data Thirty-seven patients with cervical disc herniation from December 2012 to April 2014 were selected for cervical discectomy under total endoscopy. There were 21 male cases and 16 female cases, aged between 33-58 years old, with an average of 46 years old. The duration of disease ranged from 5 months to 8 years, with an average of 3.5 years. Type of protrusion: 12 cases of central protrusion and 25 cases of paracentral protrusion. Protruding segments: 26 cases of single-segment protrusion, 9 cases of double-segment protrusion, and 2 cases of three-stage protrusion. All cases had obvious neck and shoulder pain, heavy feeling, soreness and weakness. Mild abnormal sensation in the upper limbs was observed in 16 cases, including numbness, ankylosis and sensory hypersensitivity. There were 9 cases of decreased fine hand movements, 7 cases of thoracic and dorsal girdle sensation, 6 cases of cotton tread sensation and weakness in both feet, 12 cases of positive Hoffmann’s sign bilaterally, and 5 cases of active tendon reflexes in the lower limbs. The preoperative diagnosis was based on the consistency of history, symptoms, signs and imaging manifestations (cervical dynamic hyperflexion and hyperextension radiographs, MRI and CT scan). 2.Surgery selection criteria Simple cervical disc herniation compressing the spinal cord and nerve roots, neck, shoulder and arm pain, hand numbness and pain as the main symptoms, affecting normal work and life. Those who have been ineffective for more than 3 months or have recurrent symptoms after systematic conservative treatment. MRI shows high signal of the spinal cord in one segment or two consecutive segments without jumping, and the symptoms have improved after cervical epidural drug infusion. The intervertebral height is not less than 90% of the normal value. (4) Those with clear imaging manifestations of cervical disc herniation (X, MRI, CT) and consistent with the main symptoms and signs. 3. Surgical exclusion criteria History of anterior cervical surgery. CT scan shows calcification of the herniated disc, ossification of the posterior longitudinal ligament, large osteophytes at the posterior edge of the vertebral body, hypertrophy of the ligamentum flavum, and compression of the spinal cord and nerve roots by subluxation; MRI shows that the herniated disc is free in the spinal canal. Neuronal disease. Those with hyperthyroidism and glandular enlargement. Those with mental abnormalities. 4.Surgical procedure Preoperative preparation: preoperative first day with pillow under both shoulders, head back training to adapt to the surgical position, and pneumatic and esophageal complex push-pull exercises. Iodine allergy test. The patient is introduced to the surgical procedure, and close cooperation of the patient is required for surgery under local anesthesia in a fully conscious state, and an informed consent form for surgery is signed. Procedure: The patient is placed in a supine position with a 10 cm high soft pillow under the shoulders, so that the head is tilted back to fully expose the anterior cervical region, and the C-arm X-ray machine is used to determine the lesioned vertebral space in lateral position and mark the puncture point. A 16GX 10cm cervical puncture needle was placed in the arterial and visceral sheath gap up to the middle and posterior 1/3 of the diseased intervertebral disc. The puncture needle was located in the axial position of the disc in front and side fluoroscopy. The needle core is removed and 1-2 ml of composite contrast agent (2:2:1, i.e., 2 ml of Onepac, 2 ml of 0.9% saline, and 1 ml of methylene blue) is injected, and the morphology of the herniated disc and whether the annulus fibrosus is ruptured and whether the contrast agent enters the epidural space are observed under fluoroscopy. The esophagus was observed under fluoroscopy with oral barium sulfate in relation to the puncture needle (see Figure 1). A guide wire was inserted along the needle sleeve, and after removing the puncture needle, a 3.0-mm-long incision was made along the dermatome by applying the guide wire, expanding step by step to the outer layer of the fibrous ring, screwing in the working trocar, inserting the cervical spine microscope, and slowly screwing in the working trocar to the middle and posterior 1/3 of the intervertebral disc after the annular saw cut through the fibrous ring. The nucleus pulposus tissue in the middle and posterior 1/3 was removed one by one by applying a nucleus pulposus forceps. The residual nucleus pulposus is ablated with a bipolar dual-frequency radiofrequency tip or a cervical plasma tip. In case of nucleus pulposus prolapse, the working trocar is screwed into the posterior edge of the vertebral body and removed one by one. If there is no active bleeding under the microscope, the working trocar is slowly withdrawn together with the cervical spine microscope at the same time. After surgery, the incision is closed with one stitch, dressing is applied, and the incision is pressed for 5-10 minutes. After surgery, the incision was closed with one stitch, dressing was applied and the incision was pressed for 5-10 minutes. The next day, the patient was discharged from bed under the protection of a cervical brace for 5-7 days. 5.Observation index According to the evaluation standard of the Japanese Society of Plastic Surgery, the neurological function was evaluated before and at 8 months after surgery. The scores were divided into four aspects: upper limb motor function, lower limb motor function, sensation, and bladder function. 6, Statistical methods SPSS statistical software was used for data statistics, and the four indicators of JOA scores were expressed as mean ± standard deviation (x ± SD), and t-test was performed to monitor the data before and after surgery, and P < 0.05 was considered statistically significant. Results: JOA scores at 7 months after surgery: there was a significant difference in motor and sensory improvement of the upper extremity, which were significantly relieved by the treatment, respectively (P < 0.05). There was no significant difference in lower limb motor function and bladder function before and after treatment (P > 0.05). Postoperative MRI was performed in 28 cases, and the results showed that the spinal cord and nerve root compression were basically released (see Table 1 and Figure 2). In 37 cases, the operation time was 30-50 min, with an average of 40 min. The bleeding volume was 3-15 ml, with an average of 8 ml. There was no spinal cord or nerve root injury, no intervertebral space infection, no local hematoma, no tracheal, esophageal or carotid artery injury. The incision was healed in one stage. 12 cases showed transient mild sore throat, the symptoms of neck and shoulder pain, heaviness and weakness were significantly reduced or disappeared, the abnormal sensation of upper limbs disappeared in 14 cases, the sensation of thoracic and back strapping disappeared in 4 cases, the sensation of stepping on cotton in 5 cases was normalized in 3 cases and improved in 2 cases. Discussion: Through this study, it can be seen that the anterior total endoscopic technique for cervical disc herniation can effectively improve upper limb motion and sensory disorders with fewer complications, and has better clinical application advantages than the previous posterior endoscopic technique. The key to achieve the advantage lies in: 1. Strictly grasp the indications for surgery Whether to operate must be consistent with clinical symptoms and signs and imaging performance. The intervertebral height should be strictly mastered, the intervertebral height cannot be lower than 90% of the normal worth, such as less than 90% means that the disc degeneration is obvious, no tensional compression can be said, in this case the surgery may damage the cartilage plate. Therefore, endoscopic cervical discectomy should be decided on the basis of clinical symptoms, signs and imaging manifestations consistent with the surgery. Whether the height of the cervical disc is high enough is an important condition to decide whether surgery can be performed. The above technical points should also consider key points such as the number of problematic discs and the degree of decompression. As long as the surgical indications are strictly mastered, minimally invasive endoscopic surgery can also achieve better results. 2. Key points of anterior cervical discectomy When puncturing C4-5, C5-6 and C6-7 discs, the fingertips should reach the common carotid artery as far as possible and protect it with the finger belly to avoid damage to the common carotid artery. Whenever possible, the C7-T1 disc is not punctured on the left side, so the segmental plane is crossed by the thoracic duct and often has anatomic variants. It is safe to remove the intradiscal nucleus pulposus microscopically, but extra care should be taken in cases where the fibrous ring and posterior longitudinal ligament are ruptured and the nucleus pulposus is dislodged into the epidural cavity, which can easily damage the spinal cord or nerve roots, or even rupture and bleed from the epidural cavity, resulting in serious complications from epidural hematoma. By doing the above two things, endoscopic trans-anterior cervical discectomy can achieve light injury, less bleeding, less complications, no damage to the biomechanical stability of the cervical spine, quicker recovery, significantly shorter hospitalization time, and less burden on the family and society. Of course, there are difficulties and shortcomings in the endoscopic technique as well: the cervical endoscopic technique is not as intuitive and stereoscopic as open surgery under direct vision, and the surgical approach is more limited and cannot meet a larger range of tissue removal, so special emphasis on targeted resection is the advantage of this technique. In conclusion, total endoscopic anterior cervical discectomy can effectively improve upper limb motor function and sensory impairment due to cervical disc herniation with safe surgery and few complications, and can be one of the more ideal treatments for cervical disc herniation.