I. What is lumbar disc herniation? The intervertebral disc is a layer of strong connective tissue between the adjacent upper and lower vertebrae, which plays the role of a “cushion” between the vertebrae and is mainly composed of the peripheral concentric circle-like fibrous ring and the central gelatinous nucleus pulposus and the upper and lower cartilage end plates. Degeneration, trauma and other factors can lead to lumbar disc protrusion, compression of nerve roots, causing radiated pain in the lower limbs, that is, lumbar disc herniation, commonly known as lumbar leg pain, is a common disease in orthopaedics and polyvalent. According to statistics, the incidence rate of lumbar disc herniation in China is 15.2%, that is, there are about 200 million patients in the country. Its occurrence is related to age, gender, height, weight, genes, occupation, smoking and vehicle vibration, etc., and is influenced by a combination of environmental and genetic factors. Second, how to treat lumbar disc herniation? According to the performance on MRI, lumbar discs can be classified as bulging (inclusive herniation), herniated, prolapsed, and free. If there are no obvious symptoms, no special treatment can be given. Pay attention to lumbar maintenance, do not bend over frequently, and do not lift or carry heavy objects. If there is radioactive pain, numbness or difficulty in walking in the lower limbs, and a positive straight leg raise test of the lower limbs is found, it means that the nerve root compression is serious, and decompression surgery should be performed as soon as possible. The sooner the surgery is done, the better the result will be. Delaying the disease too long will lead to nerve cell degeneration or even necrosis, which will affect the recovery of nerve function, for example, some patients have obvious relief of lower limb pain after surgery, but the numbness lasts longer. (Special reminder: patients with severe nerve compression should not perform traction, massage, massage and other treatments to avoid aggravating nerve damage.) Third, how to do minimally invasive surgery for lumbar disc herniation? Percutaneous intervertebral foraminoscopic surgery: intervertebral foraminoscopic surgery is feasible from inclusive lumbar disc herniation to huge nucleus pulposus prolapse free in the spinal canal. The skin incision is only 5 mm, and bleeding is minimal. Local anesthesia enables intraoperative interaction with the patient and is less likely to injure nerves; lateral access avoids posterior surgical harassment of the dural sac and nerve roots. Entering through the intervertebral foramen route, the anatomical structure levels of the herniated nucleus pulposus, fibrous ring, nerve roots, dural sac and hyperplastic bone tissue, posterior longitudinal ligament and ligamentum flavum are clearly presented on the screen under endoscopic direct vision operation with higher safety. The special bendable bipolar radiofrequency electrodes provide good hemostasis and ablation of adherent tissues for a clearer view during surgery; they can also be used to perform annuloplasty and destroy pain-causing peripheral nerves on the disc. This technique does not occlude the vertebral plate, does not destroy the paravertebral muscles and ligaments, has no effect on the stability of the spine, and does not require internal fixation with bone graft fusion. The patient can move to the ground after the foraminotomy, and recovery is fast. It is called “the most minimally invasive and gentle treatment for lumbar disc herniation” by the medical profession. Discoscopic surgery: For patients with lumbar disc herniation with degenerative scoliosis, high iliac crest and obesity, discoscopic surgery can be considered, but the disadvantage of discoscopy compared to foraminoscopy is that part of the lamina needs to be removed, which may destroy intervertebral stability. Minimally invasive decompression implant fusion internal fixation under the canal: for patients with lumbar disc herniation with bony spinal stenosis or intervertebral instability, foraminoscopic surgery is not suitable, and minimally invasive decompression implant fusion internal fixation under the canal is feasible, which reduces bleeding, trauma, faster recovery and shorter hospitalization time compared with traditional open surgery. Fourth, for lumbar disc herniation foraminoscopic surgery doubts Patients often ask this, can foraminoscopic surgery be complete? Will lumbar herniation recur? First of all, we need to clarify what problem needs to be solved, that is, to remove the herniated nucleus pulposus and release the nerve compression, foraminoscopic surgery can completely achieve this purpose. Secondly, we use this minimally invasive technique to give the patient one more chance, instead of doing open surgery and internal fixation right away, which not only significantly reduces surgical trauma and protects the active function of the lumbar spine, but also significantly reduces the patient’s medical expenses. The best way is to take out all the nuclei in order to prevent recurrence of lumbar herniation, which will destroy the stability and function of the lumbar spine and will not be worth the loss. V. Typical case Case 1: young female, 25 years old, with radiating pain in the right lower limb for six months, aggravated for one month. MRI: huge prolapse of the lumbar 4/5 disc, compressing the nerve. The diagnosis of “lumbar 4/5 disc prolapse” was confirmed. A percutaneous perforatorscopic nucleus pulposus was performed under local anesthesia, and the pain in the right lower extremity was relieved immediately after the operation, with obvious efficacy. Case 2: Middle-aged female, 44 years old, with low back pain with right lower extremity radiating pain for more than 2 years, aggravated for 1 month. MRI: lumbar 5/sacral 1 disc herniation, nerve compression and lumbar 5 slippage. The diagnosis was confirmed as: lumbar 5/sacral 1 disc herniation with intervertebral instability. Minimally invasive decompression TLIF implant fusion internal fixation was performed under general anesthesia, and the pain was relieved immediately after the operation.