Similar to a spinal endoscope, an intervertebral foramoscope is a light-equipped tube that enters the intervertebral foramen from the side or side and back of the patient’s body (either in a flat or oblique fashion) and performs the procedure in a safe working triangle. The surgery 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 7mm, just like the size of a soybean grain, bleeding is less than 20ml, and only 1 stitch is needed after surgery. It is completely different from the conventional open disc nucleus pulposus removal, with many advantages of small incision, less bleeding, clear vision, safer operation, less postoperative pain and faster recovery, while achieving or even exceeding the curative effect of conventional open surgery. Working Principle Intervertebral foraminoscopy is a minimally invasive spinal surgical system consisting of a specially designed foraminoscope and corresponding minimally invasive spinal surgical instruments, imaging and image processing systems to completely remove the herniated or prolapsed nucleus pulposus and hyperplastic bone to relieve pressure on nerve roots and eliminate pain caused by nerve compression. The procedure is performed through a minimally invasive spinal surgical system consisting of a specially designed intervertebral foramoscope and corresponding minimally invasive spinal instruments, imaging and image processing systems. While completely removing the herniated or prolapsed nucleus pulposus, it also removes osteophytes, treats spinal stenosis, and repairs the broken annulus fibrosus using radiofrequency technology. Eight advantages 1. Minimally invasive. The lateral approach avoids interference with the spinal canal and nerves and has no effect on the stability of the spine. 2.Direct purpose. Any herniated disc fragment can be removed. 3.Wide indications. It can deal with almost all types of herniated discs, partial spinal stenosis, foraminal stenosis, calcification and other lesions. 4.Low complications. Small trauma, no scarring at important structures after surgery leading to adhesions of the spinal canal and nerves. 5.High safety. Local anesthesia, basically no bleeding, clear surgical field, reduce the risk of misoperation. 6.Fast recovery. The next day after surgery, you can go down to the ground and resume normal work and physical exercise in 3-6 weeks on average. 7.High patient satisfaction. Immediate pain relief, simple care, can be performed as an outpatient with a skin incision of only 7mm. 8.Wide range of extension. Artificial nucleus pulposus and artificial intervertebral disc can be performed. Applicable population 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 and must meet the following conditions: 1) persistent or recurrent radicular pain; 2) more radicular pain than low back pain; and 3) ineffective with strict conservative treatment. This includes the use of steroidal or non-steroidal anti-inflammatory pain medications, physical therapy, and occupational or conditioned training procedures, with at least 4-6 weeks of conservative treatment recommended, but immediate surgery is required if there is a progressive worsening of neurological symptoms; 4. No history of substance abuse or psychological disorders; 5. Positive straight leg raise test and difficulty bending; 6. In order to precisely determine the location and nature of the herniated or prolapsed nucleus pulposus, as well as the intervertebral foraminal osteophytes situation, thorough imaging, especially CT and MRI, should be performed before surgery to accurately determine the size, location and nature of the nucleus pulposus. Experience Summary The percutaneous foraminoscopic technique can treat not only giant herniated, prolapsed, and free disc herniations. Satisfactory treatment results can also be achieved in patients with special types of disc herniation and spinal stenosis, including recurrent disc herniation and degenerative slippage, but individualized design should be performed to select an appropriate treatment plan. Satisfactory treatment results can be achieved by carefully selecting the surgical approach according to the clinical manifestations. For patients with unilateral limb symptoms, a single-segment or dual-segment approach is used based on neurolocalization signs; for patients with bilateral nerve root canal stenosis, a prone position with bilateral access or a unilateral access with bilateral decompression can be performed. The foraminoscopic technique is an effective method of treating recurrent lumbar disc herniation, avoiding the scar tissue formed posteriorly during the initial surgery and reducing the risk of dural sac tears and nerve injury. The working channel is obtained through a reaming drill, allowing direct removal of herniated discs and other compressed nerve tissue without disturbing the scar tissue and achieving direct visual decompression. Foraminoscopic treatment can be considered in elderly patients with degenerative slipped spine (I°) without significant instability. Patients are characterized by advanced age, combination of other disorders or inability to tolerate open surgical treatment; after foraminoscopic enlargement of the nerve root canal, the patient’s postoperative neurological symptoms are eliminated and the outcome is satisfactory.