He Yongjin, Department of Pain, Tianjin First Central Hospital Intervertebral foramenoscopy technology for lumbar disc herniation I. History, current status and development direction of treating disc herniation (A) Limitations of traditional technology Before the appearance of interventional disc therapy, open surgery was the only effective means of treating severe disc herniation, and interventional therapy introduced the concept of minimally invasive to the treatment of disc herniation. Currently available interventional methods include collagenase dissolution, percutaneous excision and suction, laser vaporization, plasma nucleus pulposus, ozone, and radiofrequency ablation. However, all of the above methods are indirect decompression, only for some cases of inclusive herniation, can not completely remove the diseased nucleus pulposus, especially the compression of the nerve tissue, can not repair the broken fibrous ring, necrotic tissues need to rely on the body’s natural absorption, a long time, pain, high recurrence rate. The development of posterior discoscopy in the mid-1990s has pushed the concept of minimally invasive forward, and the majority of pain doctors have gradually realized that minimally invasive technology is inevitably the direction of surgical development with the continuous emergence of new technologies and materials. However, the surgical access and treatment process of posterior discoscopy is consistent with small incision open surgery, which involves opening of the vertebral plate, stripping of muscles and ligaments, interfering with the spinal canal, and pulling the nerves (to a lesser extent than open surgery); it is prone to intraoperative hemorrhage, interfering with the field of view and increasing the risk; it cannot be applied to the treatment of extreme lateral herniation and discogenic pain; and the postoperative scar tissues are prone to cause adhesion in the spinal canal and the nerves. The emergence of “intervertebral foramenoscopy technology” has better overcome the shortcomings of the above technology, and pushed the minimally invasive treatment of disc herniation to a completely new level, which is the most minimally invasive, safest and economical technology at present; at the same time, this technology is still developing rapidly, and it has been applied in a large number of applications such as artificial intervertebral discs and artificial nucleus pulposus replacement, fusion under the foramenoscope and percutaneous technology. At the same time, this technology is still developing rapidly, and has been widely applied to artificial disc and nucleus pulposus replacement, intervertebral foramenoscopic fusion with percutaneous internal fixation, minimally invasive treatment of spinal tuberculosis and minimally invasive treatment of cervical intervertebral foramenoscopy. (II) Introduction of intervertebral foramenoscopy 1. Entering through the intervertebral foramen pathway and operating under direct endoscopic vision, relevant anatomical structures such as intervertebral discs, annulus fibrosus, posterior longitudinal ligaments, dural sacs, and nerve roots are all clearly presented on the screen at different levels, resulting in high safety and thoroughness of the operation. 2. The special bendable bipolar radiofrequency electrode can stop bleeding well, ablate the tissues adhering to the nerves and create a clear vision during the operation; it can be used for fibrous annulus molding and nerve destruction for discogenic pain. 3. The purpose of intervertebral foramenoscopy technique is direct, the patient can go down to the ground immediately after the operation and take oral antibiotics. Patients have less trauma, less pain and shorter hospitalization time. (C), intervertebral foraminoscopy technology advantages summarized: 1. wide range of indications, can deal with almost all types of disc herniation, foraminal stenosis, spinal stenosis cases; 2. surgical effect and the gold standard of intervertebral disc surgery – microscopic discectomy; 3. small trauma, no need to destroy the paraspinal muscles, ligaments, no need to bite off the vertebral plate, without affecting the stability of the spine; for the pain doctors recognized by the Department of the spinal canal; technology can clearly observe the vertebral canal, the spinal column and the vertebral canal, the spinal column and the spinal column. The technique provides a clear view of the spinal canal and nerves without disturbing them. There is no scar formation at the important structures in the back, which does not affect the remedial surgery after failure; the surgical incision is only 7 millimeters, which is in line with the aesthetic point of view. 4. High safety, complete surgery under local anesthesia, can interact with the patient, does not injure the nerves and blood vessels, minimal intra-operative bleeding, clear vision, greatly reducing the risk of misuse; 5. Simple post-operative care, only oral antibiotics can be taken, short recovery time; 6. Easily expandable to minimally invasive ways to deal with bony lesions and fusion surgery; 7. Low cost of utilization, no need for inbuilt objects. This technology platform can be expanded to cervical endoscopic treatment of disc herniation, osteophytes, hypertrophy of ligamentum flavum and other common diseases of cervical spine, which will lead to a breakthrough in the academic status of the department. Comparison between intervertebral foramenoscopy technology and other surgical methods Comparison content Intervertebral foramenoscopy Open surgery Other interventional surgery Indications Lumbar disc herniation Lumbar disc herniation Lumbar disc bulging Treatment design Removal of intervertebral disc Removal of intervertebral disc Indirect decompression Incision size 0.7cm 5-10cm 0.3cm Trauma small Large Small Anesthesia method Local anesthesia General anesthesia Local anesthesia Patient recovery time 3 days 15 days 3 days Surgery time 1-1.5 hours 3-4 hours 1-1.5 hours Hours 3-4 hours 1-1.5 hours Visibility Visible Visible Visible X-ray guidance Whether plate is placed No Plate is placed No Patient acceptance Easily accepted Not easily accepted Easily accepted Technological maturity Very mature Mature doctors Few Mature doctors Very mature Post-operative complications Few Many Few Getting down to the ground Same day One week Three days Post-operative medication Oral for 3 days Intravenous for one week Oral for 3 days