Herniated disc is a common clinical disease, at present China’s manual laborers in 15-20% of the people and most of the office white-collar workers, long-time driving people suffer from this disease. Lumbar disc herniation is the most common clinical cause of low back pain. The treatment of lumbar disc herniation should attract our enough attention. According to the severity of the disc herniation can be divided into: simple inclusion type bulging, fibrous annulus tear type protrusion, prolapse, free, patients suffering from lumbar disc herniation can be due to age, gender, time of illness and herniation of the site of a variety of different and show a variety of clinical symptoms, mainly nerve compression produces symptoms, the common clinical manifestations are as follows: (1) lumbago symptom: more than 90% of the patients have such a manifestation. The range of pain is mainly in the lower back and lumbosacral area, with persistent dull pain being the most common. The pain can be alleviated when lying down, and can be aggravated when standing and sitting. (2) Lower extremity radiating pain symptoms: it can be along the lower back, buttocks, posterior thigh, anterior or posterior lateral calf to the heel. The nature of the pain is mainly radiating tingling. Radiating pain in the lower limbs can occur before the lumbar pain, or after the lumbar pain symptoms, these two situations vary from person to person. (3) Lower limb sensory and motor function weakening symptoms: due to the damage of the nerve root, resulting in its innervation of the somatosensory area of the sensory and motor function weakened or even lost. Common manifestations include: numbness, coldness of the skin, decrease in skin temperature, etc. In severe cases, muscle atrophy or even muscle paralysis occurs. Cauda Equina Symptoms: These symptoms include numbness and tingling in the perineum, weakness in urination, and fecal incontinence. Treatment methods can be summarized into four categories: 1. Conservative treatment: generally refers to the use of physical, pharmaceutical and other treatment methods without the use of invasive and interventional methods such as open surgery or minimally invasive treatment, which can only have a certain effect on the very mild herniated disc symptoms. 2. 2, open surgery: through the epidermis, muscle, fascia, etc. to open a more than ten centimeters of incision, avoiding the nerves and blood vessels to the lesion, manual removal of lumbar disc herniation tissue, to relieve the compression of the nerve. Traditional intervertebral disc removals include the open window method, half laminectomy and total laminectomy. Minimally invasive treatment: A new treatment method that has been rapidly developed in recent years. With the help of imaging equipment and endoscopy and other visual devices, minimally invasive surgical instruments are used to enter the herniated part of the body and ablate the disc tissues or remove the nucleus pulposus in order to relieve the compression on the nerves, with the incision ranging from a few millimeters to a dozen millimeters. Interventional treatments for indirect decompression (ozone, laser, radiofrequency, plasma, collagenase, suction cutting, etc.) are gradually falling behind due to unclear results, while endoscopic removal of direct decompression (intervertebral foramenoscopy, discectoscope, Younger’s scope, laparoscopy, etc.) is truly minimally invasive, with the most advanced minimally invasive intervertebral foramenoscopic surgeries having results comparable to traditional surgeries, such as windowing. Comparison of various lumbar herniation treatments Conservative treatment: very mild symptoms Physical and medication treatments The effect is not clear Interventional treatment: inclusive, mild bulging and herniation Indirect decompression, relying on natural retraction Cannot completely remove herniation and repair tissues, the effect is not clear If the injection is inaccurate or the dosage is too large, there will be greater damage Low High recurrence rate, postoperative pain is prolonged, and there is unpredictable after-effects Invisible, blind manipulation, the treatment has no clear evaluation criteria Short, simpler, localized, and no treatment. Clear evaluation criteria Short Simpler Local anesthesia or no anesthesia Minimally invasive or open surgery can be used for revision Absorbed by the body naturally, long postoperative pain, slow recovery Minimally invasive surgery: all types of herniations, cauda equina syndrome Direct decompression, removal of herniations Completely removes the cause of compression, fast and obvious results Small incisions, basically no nerve irritation, maintains spinal structure and stability, minimal scarring Low complications, low recurrence rate, some devices Risk of nerve damage Endoscopic visualization, avoiding nerves, direct removal of herniated material Local anesthesia, patient remains awake and can give feedback on surgical sensation Open surgery: direct decompression, removal of herniated material Thorough removal of cause of compression, good and obvious results Large incisions, stripping of muscle and ligament, removal of vertebral plate, destabilization of spine, interference with spinal canal and nerves, large scars Many unpredictable sequelae, e.g. long term pain and partial dysfunction Open visualization, direct removal of herniated material General anesthesia, no feedback from patient, no way to know if there is nerve damage Very difficult to reopen Hospitalization for several days, long recovery time Comparison of different minimally invasive surgical techniques Intervertebral foramenoscopy: all types of herniated discs, including free, giant, with foraminal stenosis, and cauda equina syndromes. Percutaneous posterior intervertebral foraminal approach, Outside-In, directly in the spinal canal to the herniation site for removal, can also enter the disc decompression Direct decompression, removal of herniated material 8mm All types of herniations, especially for free herniations, L5-S1 type, with fast and obvious results Newest minimally invasive technique, developed after 2008, is in the rapid development period Wide range of indications for all types of herniations, through the enlarged intervertebral foramen to enter the intervertebral foramen, with long recovery. It can enter the spinal canal through the enlarged intervertebral foramen, and the working trocar can be easily inserted without passing through the narrow Kambin’s triangle, which avoids the damage to the traveling nerve root and ganglion caused by the process of puncture and tubing insertion. It does not damage the stability of the spine; no scar tissue will be formed after the operation, causing nerve adhesion, and the sequelae and complications are extremely low. The most minimally invasive surgery, local anesthesia, fast recovery, can be outpatient surgery, long-term efficacy is accurate and stable. Lateral Posterior Scope (YESS): Inclusive disc herniation or partial posterior longitudinal ligament subluxation type disc prolapse, unable to deal with free prolapse or giant type and L5-S1 type. Lateral posterior approach through Kambin’s triangle of safety into the disc, from the inside to the outside (In-Outside), intravertebral disc decompression Indirect decompression, mildly inclusive type can be directly decompression Inclusive type is more effective Early application time, the late 1990s, development, the technology is relatively mature Indications for the relatively narrow, difficult to take out the prolapsed type and free type fragments, for the central spinal canal and the lateral saphenous fossa stenosis, the iliac crest is higher than L5-S1 protrusion is extremely difficult to deal with. It is extremely difficult to deal with central canal and lateral recess stenosis, and L5-S1 herniation in the high iliac crest. The puncture and tube placement need to pass through the narrow triangular area, which is easy to irritate and damage the nerves, and in serious cases, it can lead to permanent damage to the nerve root function. Early, mature, simple posterior discoscopy (MED): almost all types of disc herniation, including bony stenosis and hypertrophy of the ligamentum flavum. Extremely lateral type and foraminal stenosis are relative contraindications Posterior approach to the vertebral plate, part of the vertebral plate and ligamentum flavum are removed, similar to open surgery Direct decompression, removal of herniated material The effect is similar to that of open surgery, and the efficacy is accurate and stable Started in the 1990s, there are a lot of hospitals to buy, but not many MED incision is large, bleeding is high, muscles and ligaments have to be peeled away, and some of the vertebral plates are bitten, which affects the stability of the spine; the surgery will interfere with the vertebral canal and nerves, and after the operation, it will interfere with the stability of the spinal column, which is very important for the spine. vertebral canal and nerves, postoperative may bring unpredictable sequelae, such as long-term pain and partial dysfunction, the surgery leaves a large scar, and it will become difficult to remedy the surgery again. Anterior laparoscopy: severe degeneration, spinal instability, cases requiring fixation and fusion Transabdominal access, removal of disc tissue, fusion and fixation of most of the implants Direct decompression, fusion Academic controversy, carried out early but less application Anterior laparoscopy does not interfere with the spinal nerves, does not affect the stability of the posterior column, but the technology is complex, traumatic, hospitalization time is long, and the rate of complications is very high, and even much higher than that of open surgery.