Lumbar spinal stenosis is caused by hypertrophy and hyperplasia of the ligamentum flavum in the spinal canal, hyperplasia and coalescence of the small joints, combined with bulging or herniated discs, resulting in narrowing of the central canal, nerve root canal, or lateral saphenous fossa of the lumbar spine, and eventually compression of the cauda equina or nerve roots, resulting in corresponding neurological dysfunction. For patients with severe lumbar spinal stenosis, intermittent claudication with pain and numbness can seriously affect their quality of life. The onset of this type of patients is mainly after middle age, and they tend to be older, have more segments, poor surgical tolerance, and have a certain fear of surgery. At this time, he often hopes to improve his symptoms through minimally invasive techniques. And is the conventional minimally invasive technique suitable for this type of patients? Let’s take a look at some of the minimally invasive techniques currently available in China. The classification of minimally invasive techniques for lumbar spine: 1. Percutaneous perforator nucleus pulposus chemical lysis, percutaneous perforator disc excision and suction (PLD), percutaneous laser disc vaporization (PLDD), percutaneous perforator ozone nucleus ablation, etc. This type of technology should be accurately defined as interventional treatment, which is to indirectly relieve nerve compression by reducing the pressure in the disc or removing part of the disc tissue. It is suitable for simple disc herniation (smooth surface of the annulus fibrosus, clear boundaries, no sharp angle formation). It is not suitable for those whose nucleus pulposus is free in the spinal canal or those with spinal stenosis or slippage. Postoperative symptom recovery is closely related to the choice of indications, and the incidence of incomplete postoperative symptom relief is relatively high. 2, intervertebral foraminoscopic disc removal (PELD): is to remove the herniated tissue, remove the bone and release the nerve compression with the assistance of endoscopy. It is suitable for most types of disc herniation and partial ossification stenosis cases. However, the incidence of rebound pain, incomplete symptom relief, and re-protrusion of the disc is relatively high after the operation. Moreover, the operation is technically demanding and the learning curve for the surgeon is long. 3. Discoscopic disc removal (MED), which is a more popular minimally invasive technique. It is minimally invasive and endoscopic based on traditional lumbar disc surgery, with special surgical instruments that allow decompression of nerve roots under direct vision. It is suitable for most types of lumbar disc herniation and single-segment lateral saphenous fossa stenosis and/or nerve root canal stenosis. The technique, however, has a longer operation time, a smaller amount of bone grafting, a narrower intraoperative field of view, and a longer learning curve. The classification of minimally invasive techniques for the lumbar spine shows that there is no one method that is suitable for patients with severe lumbar spinal stenosis. During consultations, many patients with severe lumbar spinal stenosis consult us with the same question, “Can I have minimally invasive surgery on my lumbar spine?” In fact, the current conventional treatment for lumbar spinal stenosis is still primarily total laminectomy decompression. Considering that total laminar decompression is more destructive to spinal stability and has more intraoperative bleeding, combined with the minimally invasive concept, my experience is that changing the method of conventional total laminar decompression surgery to bilateral open decompression, preserving the spinous process, part of the lamina, and the supraspinous and interspinous ligaments, and preserving the intact posterior tension band structure, can better protect the dynamic stabilization system of the spine and maintain spinal stability, while reducing intraoperative bleeding. Trimming the inferior articular process under the chisel during decompression to the shape of an intervertebral fusion will both increase the amount of bone graft and reduce the cost of treatment. Postoperatively, patients can generally be out of bed in 3-4 days under the protection of a lumbar girth, reducing the various complications associated with long-term bed rest. At present, this minimally invasive technique has become my routine operation method in the treatment of severe lumbar spinal stenosis. Compared with the traditional total laminectomy decompression, this method has fast postoperative recovery and significantly reduced postoperative lumbar pain symptoms.