1. Overview of intervertebral foramenoscopy technology Similar to a spinal endoscope, an intervertebral foramenoscope is a tube equipped with a light, which enters the intervertebral foramen from the side of the patient’s body or from the side and back (in a way that can be either flat or slanted) to carry out the surgery in a safe working triangle. Surgery is performed outside the annulus fibrosus of the intervertebral disc, where the herniated nucleus pulposus, nerve roots, dural sac, and proliferating bone tissue can be clearly seen under direct endoscopic vision. Then various types of grasping forceps are used to remove the protruding tissues, microscope to remove the bone, and radiofrequency electrodes to repair the broken annulus fibrosus. Surgical trauma is small: the skin incision is only 7mm, like the size of a soybean grain, the bleeding is less than 20ml, and there is only 1 stitch after surgery. It is the minimally invasive treatment for herniated disc with the least trauma to the patient and the best effect among similar surgeries. 2.Intervertebral foramenoscopy technology treatment principle Intervertebral foramenoscopy completely removes the protruding or prolapsed nucleus pulposus and hyperplastic bone outside the intervertebral foramen safety triangle and intervertebral disc fibrous ring to relieve the pressure on the nerve root and eliminate the pain due to the compression of nerves, and the surgical method is a spine minimally invasive surgical system composed of a specially designed intervertebral foramenoscopy and the corresponding supporting minimally invasive surgical instruments for the spinal column and the imaging and image processing system. minimally invasive spinal surgery system. While completely removing the protruding or prolapsed nucleus pulposus, it removes osteophytes, treats spinal stenosis, and can use radiofrequency technology to repair the broken annulus fibrosus. 3, intervertebral foraminoscopy access location (1) simple disc herniation and partial prolapse type cases, preferred posterior lateral safe triangle approach. (2) Distal lateral level approach is suitable for central massive herniation. (3) Posterior or interlaminar approach is suitable for free or calcified type patients (4) Applicable to almost all types of disc herniation and some cases of bony stenosis 4. Indications for minimally invasive intervertebral foramenoscopic spine surgery The selection criteria for intervertebral foramenoscopic or endoscopic microdiscectomy do not differ essentially from those for laminotomy and discectomy. Patients with herniated discs selected for minimally invasive surgery must exhibit signs and symptoms of nerve root compression and must meet the following criteria: (1) persistent or recurrent radicular pain; (2) radicular pain greater than low back pain. Patients with less than moderate bulging who have more low back pain than leg pain may first undergo cryo-plasma myeloplasty; (3) Failure of strict conservative treatment. This includes the use of steroidal or nonsteroidal anti-inflammatory pain medications, physical therapy, and occupational or conditional training procedures. Conservative treatment is recommended for at least 4-6 weeks, but if progressive exacerbation of neurologic symptoms occurs, immediate surgery is required; (4) No history of substance abuse or psychological disorders; (5) Positive straight-leg raising test and difficulty in bending over; (6) In order to accurately determine the location and nature of the protruding or prolapsing nucleus pulposus, as well as the foramina (6) In order to accurately determine the location and nature of the herniated or prolapsed nucleus pulposus, as well as the intervertebral foramen, a thorough imaging examination should be performed before the surgery. 5. Features of intervertebral foramenoscopy technology (1) Clinical advantages of intervertebral foramenoscopy Intervertebral foramenoscopy technology under local anesthesia through the lumbar lateral pathway route, to complete the microscopic removal of the nucleus pulposus of the intervertebral disc, and to instantly relieve the patient’s pain. After the operation, the patient’s symptoms are relieved as normal and he can be discharged from the hospital within three days. This technique removes herniated disc tissue under endoscopic surveillance through a special lateral intervertebral foraminal approach, which is less invasive than the usual posterior surgery. Typical laminectomies inevitably cause extensive damage to structures important for spinal stabilization in order to approach the target point, which usually requires immediate spinal fusion. In contrast, the laminectomy technique progressively enlarges the intervertebral foramina with a patented reamer and appropriate medical instrumentation, completely removing any protruding or detached fragments as well as the degenerated, inflamed nucleus pulposus. It can also provide continuous irrigation and anti-inflammation of the lesion, use radiofrequency electrodes to repair the fibrous ring, ablate nerve-sensitizing tissues, and block the circumferential nerve branches to relieve the patient’s soft tissue pain. (2) Comparison between intervertebral foraminoscopy and other treatments Compared with indirect decompression techniques such as nucleus pulposus mechanical excision and decompression, chemical nucleus pulposus dissolution, or laser vaporization, intervertebral foraminoscopy disc removal is a direct technique for targeting excision of protruding disc fragments and decompression of nerve roots. Although posterior discoscopy (MED), which has been widely recognized in recent years, can be applied to various types of lumbar disc herniation, its minimally invasive nature is limited because its surgical access and surgical procedure are the same as that of small-incision open surgery, which requires paraspinal muscle access and implementation of vertebral plate opening and resection of the muscular ligamentous and osseous structures. Intervertebral foramenoscopy has the obvious advantages of less trauma, less bleeding, easier anesthesia, faster postoperative recovery, and lighter economic burden. (3) Minimally invasive intervertebral foraminoscopy vs. traditional surgery Minimally invasive intervertebral foraminoscopy Traditional surgery Trauma size: visual operation, minimally invasive, only 6mm, need to open the vertebral plate, leakage of the talent, the nucleus pulposus, the wound is about 6cm Surgery time: shorter, 60-90 minutes Surgery time is relatively long Safety: safer, clear vision, can effectively avoid the risk of misuse of the wound. Avoiding the risk of malpractice, easy to appear wound adhesion, etc., the risk is greater Surgical efficiency: about 97.5% about 94.6% Bleeding: very little, almost no bleeding 90 ± 20 ml Pain: no pain, a little pain in the postoperative period Analgesic use: local anesthesia, about 10n spinal anesthesia, about 52n Bedtime: about 1 day 7–8 days Hospitalization: 3–5 days Hospitalization time: 3-5 days 17-24 days Postoperative care: easier, can basically take care of oneself after 1 day More complicated, need to drain the wound after surgery, etc., need to sit and stand after 6 days Recurrence rate: less than 3%, almost no recurrence More than 10%, higher Rehabilitation time: faster, 3-6 weeks Average 6.5-20 weeks