The foraminoscope was first developed in 1999 by Professor Anthony Yeung in the USA (Yeung’s technique) and in 2002 by Professor Thomas Hoog Land of the German Society of Spine Surgery, the innovative Thessys technique is now widely recognized by scholars in the spine field. This technique is not only used for the treatment of herniated discs, but also for the treatment of various types of bony stenosis and age-related degeneration. Because the Thessys technique works outside the annulus fibrosus, the integrity of the annulus fibrosus is maintained to the greatest extent possible and the stability of the spine is preserved, making it the least invasive and most effective procedure of its kind. Minimally invasive intervertebral foraminoscopy represents a new concept of minimally invasive spine surgery. It can perform herniated discs, foraminoplasty and repair of the fibrous ring in all segments from the cervical spine to lumbar 5 sacral 1. The satisfactory outcome of the surgery can reach 75% – 90%. Because of its many advantages, the international field of minimally invasive spine surgery has now recognized the dominance of intervertebral foraminoplasty in not field. 1, the basic principle with the development of the spinal endoscopic transvertebral foraminal access maturity and application, we gradually accept the application of Thessys technology, also become the current mainstream method of intervertebral foraminal technology. The basic principle of its operation: its purpose is to remove the pressure on the nerve root and eliminate the pain caused by nerve compression by completely removing the herniated or prolapsed nucleus pulposus and hyperplastic bone in the safety triangle of the intervertebral foramen, outside the disc fibrous ring. The procedure is performed through a minimally invasive spinal surgery system with intervertebral foraminoscopy and corresponding surgical instruments, imaging processing system, and Ellman dual-frequency radiofrequency machine. While completely removing the herniated or prolapsed nucleus pulposus, it removes osteophytes, treats spinal stenosis, and can repair broken rings using radiofrequency technology. It is important to note here that the key difference between the Yeung technique and the Thessys technique is whether or not it goes inside the disc. the Yeung technique is also confusing to physicians and is often interpreted as a replica of discotomy and aspiration. Early hospitals that performed this technique did so because of the high recurrence rate of patients who had the procedure, making physicians less confident that such instances would continue to exist. During the operation of this technique, the surgeon must rely on high-quality C-arm imaging and videography and the procedure is completed successfully. Surgical approach In order to precisely determine the location and nature of the herniated nucleus pulposus, as well as the osteophytes of the intervertebral foramen, a thorough clinical and neuro-osteopathic examination is performed prior to surgery. Imaging, especially MRI, is an important tool to precisely determine the size, location and nature of the nucleus pulposus. The final diagnosis is confirmed by discography. Appropriate patient position and precise design of the approach are key to the outcome of the procedure. Intervertebral foraminoscopy combines the approach and technique to perform all disc nucleus pulposus removal, fibrous annuloplasty, and removal of osteophytes from the cervical spine to lumbar 5 sacral 1. Any herniated or even free nucleus pulposus tissue can be removed through this system. The special way to reach a herniated disc using this method is through the foramen safety triangle, which is usually narrowed significantly in the case of a prolapsed disc, requiring removal of the dislodged nucleus pulposus tissue by grinding the borescope and using specially developed biting forceps, graspers, etc. It is one of the core techniques regarding spinal endoscopy that allows smooth access via the vertebral working channel, which is one of the core techniques regarding intervertebral foramina. The specific surgical steps can be specifically divided into nine parts: Step 1: Preoperative preparation MRI of the lumbar spine is needed to understand the morphology of the herniation, and DR of the lumbar spine to understand the height of the intervertebral foramen and iliac spine; Step 2: Marking the site of needle entry The general paracentral opening distance is between 11-14 cm and marked; Step 3: Local anesthesia; Step 4: Puncture and placement of the guidewire until the disc is inside; Step 5: Discography Using The nucleus pulposus is stained blue with a mixture of methylene blue and iodophor 1:4 in 1-2 ml to facilitate observation of the morphology of the disc herniation and its removal; Step 6: Enlargement of the intervertebral foramen with a grinding drill. Step 7: Placement of working trocar and intervertebral foramoscope; Step 8: Removal of stained herniated nucleus pulposus tissue and exploration; Step 9: Application of bipolar radiofrequency defibrillation ring. 2.Technical advantagesFor a long time, laminectomy and lumbar disc removal were the only surgical treatment methods for patients with severe disc herniation. Due to the lack of good specific diagnostic methods and treatments, physicians continue to offer a wide variety of physical therapies to patients depending on their condition. In the face of new surgical treatments, some conservative physicians remain stubbornly committed to their old views as they await scientific proof of the new therapies. To date, conservative treatments are the only ones that have not been challenged. However, as a viable new technology and approach, the “gray area” treatment, which can reduce pain and provide better specificity in diagnosis, is a bridge between conservative and surgical treatment. Minimally invasive intervertebral foraminoscopic spine technology is a well-established and proven technique that has only been introduced to the world since the famous German operation. It has some major advantages as follows: (1) Wide range of indications: it can deal with almost all types of disc herniation, some spinal stenosis foraminal stenosis, calcification and other bony lesions. With the use of special radiofrequency electrodes under the scope, fibrous annuloplasty and sinus nerve branch discogenic pain are feasible. (2) Through the lateral approach to directly reach the location of the lesion, avoiding the interference of posterior surgery on the spinal canal, without biting off the vertebral plate, without destroying the paravertebral muscles and ligaments, and without adhesions to the stability of the spine. It can also prevent postoperative segmental instability and slippage. (3) High safety, the patient only needs local anesthesia, and the patient’s reaction can be observed at any time during the operation. (4) The complications are less traumatic, and the risk of nerve injury and thrombosis is extremely low. (5) The skin incision is only 7 mm, and the recovery is fast, and the patient can go to the floor the next day after the operation, and return to normal work and physical exercise in 3-6 weeks on average. (6) High patient satisfaction, high comfort level, immediate pain relief, mild postoperative pain, self-care of urine and stool, and easy care. (7) The Ellman radiofrequency electrode pair used at the same time can protect the integrity of the fibrous ring and posterior longitudinal ligament, thus reducing the recurrence rate of postoperative disc herniation. The calcified disc can be removed at the same time; the specially designed bipolar radiofrequency electrodes can perform good hemostasis and fibrous annulus repair molding in disc surgery. (8) Published international literature has reported success rates of more than 90% at 1 and 2 years postoperative follow-up, with early recurrence rates of less than 5%. Among patients with open surgery recurrence, the success rate exceeds 84%. 3, technology comparison now most scholars believe that: posterior discoscopy and conventional small incision open surgery compared to no advantage, the degree of impact on the spine is basically the same, while the limited field of view, and is not conducive to clinical operation, from the international point of view of the use of posterior discoscopy, Europe and the United States hospitals to carry out this technology is not rare,. In China, there are more than 500 hospitals purchase posterior discoscope, but more than 2/3 of the hospitals basically no longer use it after having done some surgery at the initial stage of purchase, and a few other hospitals occasionally carry out, which is very much in line with this understanding of the development journey of the author’s hospital, we also basically stop using posterior discoscope after carrying out nearly 200 cases. Minimally invasive techniques are bound to be the direction of development in surgery. However, the surgical access and treatment process of posterior discoscopy are consistent with small incision open surgery, which requires epidural anesthesia, laminar opening, stripping of muscles and ligaments, interference with the spinal canal, stretching of nerves, easy intraoperative bleeding, interference with the visual field and increased risk; it cannot be applied to the treatment of extreme lateral herniation and discogenic pain; postoperative scar tissue is likely to cause adhesions to the spinal canal and nerves, and re-mediation of surgery is also The postoperative scar tissue is likely to cause adhesions to the spinal canal and nerves, and re-remediation is very difficult. The foraminoscopic technique can treat all types of disc herniations in the thoracolumbar segment, not only by directly removing the herniated tissue, but also, if necessary, by removing the entire disc cleanly for fusion and fixation. The core of this minimally invasive technique is that it does not pass through the posterior approach, leaving no scarring in the posterior after surgery and causing no adhesions to the spinal canal or nerves. Even if the surgery fails, a further posterior procedure looks from the posterior as if no surgery had been performed. The equipment used not only completes minimally invasive surgery, but also takes into account the needs of some pain management areas. For example, the radiofrequency machine used in this system can perform “radiofrequency ablation”, or IDET, which is mainly used for neurodesis of discogenic pain, together with fibroplasty, and if necessary, intravertebral disc nucleus ablation and partial target ablation. The lumbar disc herniation misunderstanding domestic treatment and diagnosis of lumbar disc herniation has reached a high level, but because the symptoms of lumbar disc herniation easily confuse patients and doctors, there are many misunderstandings in diagnosis and treatment, and many people even think that lumbar disc herniation is an incurable disease. So what are the misconceptions about the treatment of lumbar disc herniation? Myth 1: Lumbar pain is not considered a disease. A survey shows that more than 95% of people have suffered from lumbar pain disease in their lifetime. Some of the primary diseases of low back and leg pain are cured and the pain will cease to exist. There are also some that do not heal themselves. Therefore, some patients think that low back and leg pain is not a disease. In fact, low back and leg pain caused by lumbar disc herniation is not only a disease, but also needs to be paid great attention to. Because this disease can cause not only low back and leg pain, but also lower limb numbness, weakness, and even paralysis and other disorders, seriously affecting the health problems of life. Myth 2: Low back and leg pain is not curable lumbar disc herniation is characterized by easy recurrence. Therefore, some patients, and even some doctors, believe that lumbar disc herniation cannot be cured. In fact, the overall effect of lumbar disc herniation treatment is very good, about 90% or more effective. There are two reasons why the so-called cure is not good: one is the improper choice of method, and the other is the lack of adherence to treatment. Some patients go to where they hear that there is a new treatment, where they go as long as they do not operate, but where they can not adhere to, and ultimately is running a lot of places, but the effect is not very satisfactory. Misconception 3: Blind surgery or refusal to operate on the issue of surgery, patients generally produce two very different opinions: one is blind surgery, the other is to refuse surgery. The former believes that only surgery can cure lumbar disc herniation, in fact, the indications for lumbar disc herniation surgery are very strict, but surgery is not the first choice for treating lumbar disc herniation; the latter further amplifies the negative effects of surgery, such as nerve damage, and believes that surgery must not be done and conservative treatment is used. In fact, most patients with lumbar disc herniation can be cured by minimally invasive intervention (a latest method between surgery and non-surgery), with a one-time treatment time of only 3~5 minutes, so minimally invasive intervention has become the best choice for most lumbar disc herniation indications today. Low complications Low trauma, low chance of thrombosis and infection formation; no postoperative scarring at important posterior structures causing adhesions to the spinal canal and nerves. High safety Local anesthesia enables intraoperative interaction with the patient without injury to nerves and blood vessels; basically no bleeding, clear surgical field of vision, greatly reducing the risk of malpractice; fast recovery The patient can get down to the floor the next day after surgery and return to normal work and physical exercise in an average of 3-6 weeks. High patient satisfaction Immediate pain relief, self-care of urination and defecation, simple care, oral antibiotics are sufficient, skin incision is only 7mm, in line with the aesthetic point of view. Wide range of extension Combined with percutaneous fixation techniques, fusion and fixation of spinal slippage and instability can be accomplished in a minimally invasive manner; this basic platform can be easily extended to cervical disc endoscopic surgery. The advantages of intervertebral foraminoscopy technology in minimally invasive spine surgery are as follows: (1) Intervertebral foraminoscopy technology is similar to spinal endoscopy in that it is a tube equipped with a light that enters the intervertebral foramen from the side or back of the patient’s body and operates in the safety triangle. (2) Foraminoscopy removes pressure on the nerve roots by completely removing the herniated or prolapsed nucleus pulposus and hyperplastic bone outside the foramen’s safety triangle, outside the disc’s fibrous annulus, to eliminate pain. (3) The selection criteria for foraminoscopic disc removal are not fundamentally different from those for laminectomy and disc removal. (4) Clinical advantages of foraminoscopic orthopedics: In 2010, many patients with lumbar disc herniation in China have been successfully performed disc nucleus pulposus removal surgery, achieving reliable results, immediate relief of patient pain and short-term return to normal work after surgery. (5) Intervertebral foraminoscopic technique: removal of herniated disc tissue under endoscopic surveillance is less traumatic than the usual posterior surgery, and radiofrequency fibrous ring repair can be performed at the same time. (6) Intervertebral foramoscopy has obvious advantages over posterior discoscopy (MED) in terms of less trauma, less bleeding, easier anesthesia, faster postoperative recovery and less financial burden. The procedure is performed in a safe working triangle. The procedure is performed outside of the disc annulus fibrosus, 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, like the size of a soybean grain, bleeding is less than 20ml, and only 1 stitch is needed after the operation. It is the least traumatic and most effective minimally invasive treatment for disc herniation among similar surgeries. Intervertebral foraminoscopy treatment principle: Intervertebral foraminoscopy removes the pressure on the nerve root and eliminates the pain caused by nerve compression by completely removing the herniated or prolapsed nucleus pulposus and hyperplastic bone outside the intervertebral foramen safety triangle and disc fiber ring. Minimally invasive spine surgery system. While completely removing the herniated or prolapsed nucleus pulposus, it also removes osteophytes, treats spinal stenosis, and can repair broken annulus fibrosus using radiofrequency technology. The selection criteria for foraminoscopic 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 lumbar pain. If the symptoms of lumbar pain are greater than leg pain in patients with moderate or less bulging can first do cryogenic plasma meduloplasty; 3, after strict conservative treatment has failed. including the use of steroidal or nonsteroidal anti-inflammatory pain medications, physical therapy, and occupational or condition training procedures, conservative treatment is recommended for at least 4-6 weeks, 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. To precisely determine the location and nature of the herniated or prolapsed nucleus pulposus and the intervertebral foraminal osteophytes situation, thorough imaging examinations, especially CT and MRI, should be performed before surgery to accurately determine the size, location and nature of the nucleus pulposus. Comparison of intervertebral foraminoscopic techniques with other orthopaedic treatments: It is understood that this technique removes herniated disc tissue under endoscopic surveillance through a special lateral foraminal approach, which is less invasive than the usual posterior approach. Typical laminectomy in order to approach the target point necessarily causes extensive damage to structures that play an important role in spinal stability, which usually requires immediate spinal fusion. In contrast, the laminectomy technique gradually enlarges the intervertebral foramen with a patented reamer and corresponding medical instrumentation, completely removing any herniated or prolapsed fragments as well as the degenerated inflamed nucleus pulposus. It also provides continuous irrigation of the lesion to reduce inflammation, uses radiofrequency electrodes to repair the annulus fibrosus, ablates nerve sensitizing tissue, blocks the annular nerve branches, and relieves the patient of soft tissue pain. Comparison of intervertebral foraminoscopy with other treatments: Compared with indirect decompression techniques such as mechanical nucleus pulposus excision and decompression, chemical nucleolysis or laser vaporization, intervertebral foraminoscopic disc removal is a direct technique for targeted removal of herniated disc fragments and decompression of nerve roots. Although the posterior discoscopic technique (MED), which has been widely recognized in recent years, can be used for all types of lumbar disc herniation, its minimally invasive nature is limited because its surgical approach and procedure are the same as that of small-incision open surgery, which requires a paravertebral muscle approach and implementation of a laminar opening with removal of muscle ligaments and bony structures. Compared with intervertebral foraminoscopy, it has obvious advantages such as less trauma, less bleeding, easier anesthesia, faster postoperative recovery and less economic burden.