The purpose of minimally invasive spinal foraminoscopy is to relieve pressure on nerve roots and eliminate pain due to nerve compression by removing herniated or prolapsed nucleus pulposus and hyperplastic bone in the safe triangle of the intervertebral foramen, inside and outside the disc’s fibrous annulus. The procedure is performed through a minimally invasive spine surgery system consisting of a specially designed intervertebral foramoscope, corresponding minimally invasive spine surgery instruments, imaging and image processing systems, and a dual-frequency radiofrequency machine, which allows various surgical operations to be performed in a very small canal space. Fu Qiang, Department of Spine Surgery, Shanghai Changhai Hospital This technique can remove herniated or prolapsed nucleus pulposus while also removing osteophytes, treating spinal stenosis, and allowing repair of broken annulus fibrosus using radiofrequency technology. Using foraminotomy allows precise surgery of the disc without damaging normal tissue. The minimally invasive laminectomy technique is the least invasive and most effective procedure of its kind because it maintains the integrity of the annulus fibrosus and the stability of the spine to the greatest extent possible. Minimally invasive intervertebral foraminoscopy represents a new concept of minimally invasive surgery. It can perform herniated discs, foraminoplasty and repair of the annulus fibrosus in all segments from the cervical spine to the lumbar 5-sacral 1. The satisfactory outcome of the surgery can reach 90%. Because of its many advantages, foraminotomy is now recognized as the leading surgical procedure in the field of international spine surgery. A thorough skeletal and neurological examination is performed prior to surgery in order to precisely determine the location and nature of the herniated or prolapsed nucleus pulposus, as well as the condition of the intervertebral foraminal osteophytes. Imaging, particularly CT and MRI, are important to accurately determine the size, location, and nature of the nucleus pulposus, and intraoperative discography can also be used to confirm the diagnosis. Minimally invasive intervertebral foraminoscopic spine surgery: This technique can be used for minimally invasive surgery for all types of disc herniation. The nucleus pulposus is usually removed via a lateral foraminal approach under local anesthesia, and for more unusual types of herniation, minimally invasive removal can also be performed via a posterior approach. Appropriate patient positioning and precise design of the approach from the skin to the herniated disc are essential to obtain a good surgical outcome. The lateral or prone position can be chosen depending on the location and nature of the herniated or prolapsed nucleus pulposus. Removal of the nucleus pulposus from all discs from the cervical spine to the lumbar 5-sacral 1, fibrous annuloplasty, and removal of osteophytes can be performed. The access to the herniated disc using the lateral posterior approach is through the foraminal safety triangle, which is usually narrow in the case of a prolapsed disc. The affected nerve roots emanate from the cephalad side and are usually encircled by fibrous tissue and/or bony structures. In order not to irritate the nerves near the foramen and to ensure safe access to the spinal canal, the foramen often needs to be enlarged by a specially designed drill. A guide wire and a stepped puncture cannula are made to be manually inserted into the intervertebral foramen under the supervision of a C-arm machine. The intervertebral foramen is gradually widened by removing bony structures through a multi-stage grinding drill. This allows safe access to the spinal canal. The herniated nucleus pulposus causing the symptoms is then removed through a working channel and specially designed spinal foraminoscope using a series of specialized ultra-fine surgical instruments. Published international literature reports have confirmed the success rate obtained with this minimally invasive technique to be over 90% with an early recurrence rate of less than 5% after 2 years of postoperative follow-up. In cases of recurrent disc herniation, the success rate exceeds 85%. The minimally invasive intervertebral foraminoscopic spine technique is a well-established and mature set of techniques that has some major advantages: 1. The patient requires only local anesthesia and does not need general anesthesia. The procedure is done with the patient fully awake. The patient’s reaction can be detected at any time during surgery.2. The surgical site is reached through a very small percutaneous incision, minimizing the risk of infection during and after surgery.3. Unlike the microsurgical technique, the foraminal approach does not require partial removal of the intervertebral ligament (ligamentum flavum), conus or intervertebral joint (conus laminectomy) in order to locate and remove the herniated or prolapsed nucleus pulposus, nor does it require Cutting of the paraspinal muscles increases postoperative stability and reduces wound pain and extensive scarring.4. Less bone tissue is removed, reducing blood leakage and scar formation in the nerve root area.5. Recovery after surgery is rapid, with patients being able to be on the floor one day after surgery. The patient can return to work and ensure a high quality of life as soon as possible.6. The unique design of the cannula and surgical instruments protects the nerve roots, the epidural and perineural venous system, prevents venous stasis and chronic neuroedema. It can reduce perineural and epidural scar formation.7. It will not damage the dura and nerve structures and reduce the occurrence of nerve root injury. The use of working cannulae can reduce paravertebral muscle injury and loss of innervation. The stripping and pulling of the paravertebral muscles during open surgery can often damage the paravertebral muscles and denervate the muscles. In addition, postoperative segmental instability and slippage can be prevented.8 In accommodative disc herniation, the integrity of the posterior annulus fibrosus and posterior longitudinal ligament can be protected, thereby reducing the chance of recurrence of postoperative disc herniation.