Minimally invasive technology solves a major problem for patients with complex low back and leg pain—Talking about total endoscopic lumbar fusion in precision spine surgery technology He Erxing, Department of Spine Surgery, The First Hospital of Guangzhou Medical University, Guangzhou, China He Erxing, Department of Spine Surgery, The First Hospital of Guangzhou Medical University, Guangzhou, China He Erxing, Department of Spine Surgery, The First Hospital of Guangzhou Medical University, Guangzhou, China The prevalence of low back pain is very high in the population, with about 90% of adults having experienced low back pain at one time or another. There are many causes of low back pain, including injury, inflammation, tumor, deformity and so on, the most common of which is degenerative changes, commonly known as aging or strain injury. Patients say that herniated discs, spinal stenosis, lumbar instability, sciatica, etc., all belong to this category. The vast majority of low back pain can be treated well through conservative treatment such as rest, adjustment of labor or activity patterns, physical therapy, etc. Only a very small percentage eventually have to be solved by means of surgery. When it comes to surgery, people think of the trauma caused by surgery. Almost all people hope that the less traumatic the surgery is, the better, as long as it solves the problem. Highly qualified surgeons also set standards for their work: 1) to solve the problem; 2) to be less invasive; and 3) to preserve as much of the original organ function and structure as possible. This is the technical standard required by the so-called precision surgery. Whether a surgery is minimally invasive or not is relative. Due to the contemporaneous technical conditions, there is no unified standard, and the name is used rather arbitrarily. For example, the technique of simply removing a lumbar disc with a 150px long surgical incision is open surgery. However, when removing a severe spinal tumor, it is already considered very minimally invasive if the surgery can be completed with the same large incision. Therefore, it is not perfect to express the degree of damage of the surgery with only minimally invasive. Excellent surgical techniques need to be precise and at the same time minimally invasive. Simple minimally invasive surgery, mainly for patients with early lumbar spine lesions and less damaged discs, is technically mature and has more surgical options available. Common ones are foraminotomy, discoscopic discectomy, radiofrequency ablation, disc dissolution, etc. Lumbar fusion is mainly used for patients with severe lesions and is a widely used procedure with good immediate and long-term results, and is considered the gold standard for judging other treatment methods. When the lumbar spine lesion has progressed to a certain level, the surgeon must consider factors such as removal of the disc, canal osteotomy and decompression, orthopedic and reconstruction of the stability of the spine, and more importantly, whether the spine can withstand the test of prolonged use and whether the disease will recur when dealing with the patient. Therefore, the surgical protocol developed is more complex. Lumbar spine fusion actually consists of several sets of techniques that fail to be fully minimally invasive under current technical conditions. Therefore, in most hospitals doctors can only use the open conventional approach. Fully open lumbar fusion is highly invasive, and the trauma of the procedure even affects the patient’s recovery time or leaves after-effects. The small incision, or semi-minimally invasive procedure as it is called, again suffers from poor visualization. The combination of fully endoscopic lumbar fusion with percutaneous pedicle screw fixation is the goal of achieving a fully minimally invasive lumbar fusion, and has been a technical challenge for spine surgeons for a long time. The steeper learning curve required by the special technique of microscopic operation, the mismatch between the size of the endoscopic channel and the currently used intervertebral fusion device, and the imperfection of the related tools are the main reasons. The Department of Spine Surgery of the First Affiliated Hospital of Guangzhou Medical University has been constantly striving for research and innovation in minimally invasive treatment techniques. Recently, the endoscopic system and the fusion device used have been designed and improved accordingly, and a set of effective operation techniques have been developed, so that full endoscopic lumbar fusion can finally be routinely applied to patient treatment. Both total endoscopic lumbar fusion and percutaneous pedicle screw fixation are precise and minimally invasive techniques. This combination of techniques, in lieu of conventional open lumbar fusion, can completely resolve most complex lumbar spine disorders. The surgery causes minimal damage to the original structure and function of the spine, reducing the pain associated with surgical injury, and patients can be discharged from the hospital with early recovery. This article is authorized by Dr. Erxing He.