According to past experience, lumbar disc herniation can be treated in three steps: first step: for mild to moderate herniation, standardized conservative treatment for 3 months, including oral medication, attention to posture and functional exercise, etc., most of which can relieve symptoms without surgical treatment. The second stage: if the conservative treatment is not satisfactory, then minimally invasive interventional treatment is recommended, commonly used methods include radiofrequency ablation of the intervertebral disc, ozone ablation of the intervertebral disc, and nerve root block. However, the above methods are indirect decompression, only for some cases of inclusive herniation, and cannot completely remove the diseased nucleus pulposus, especially the tissue compressing the nerve, and the necrotic tissue needs to be absorbed naturally by the body, which is long, painful and has a high recurrence rate. Third stage: Those who cannot be solved by the above minimally invasive surgery, whose symptoms gradually worsen and seriously affect their daily work and life need open surgery (for severe protrusion, prolapse or free, early surgery is recommended). The purpose of surgical treatment is to remove the herniated disc so that the compressed nerve can regain free space. The decision to perform the surgery is based on the location and extent (size) of the herniated disc and the accompanying other problems (such as spinal stenosis, arthritis, etc.). The surgical procedures include: endoscopic discectomy, microscopic discectomy, small incision discectomy, discectomy combined with interspinous elastic internal fixation, discectomy combined with arch nail internal fixation and bone graft fusion. Surgical removal of the herniated disc is a direct decompression, but the surgery is traumatic, risky and expensive, and also has a high recurrence rate of pain (inflammatory irritation, blood irritation, tissue adhesions, etc.), in addition, some patients still have pain symptoms after surgery, and even new postoperative back pain (low back surgery pain syndrome), long-term oral pain medication or nerve block and other treatments in the pain department. Therefore, many patients with cervical and lumbar disc herniation desire an ideal method that is non-invasive, less invasive, less painful, faster recovery, more effective, safe and simple. Intervertebral foraminoscopy —- Minimally invasive technology for disc herniation Indications: 1, spinal nerve root pain caused by disc herniation and intervertebral foraminal osteophytes, with poor results from conservative treatment; 2, central, paracentral, lateral, and extreme lateral lumbar disc herniation; 3, some patients with lumbar foraminal stenosis; 4, patients with cervical disc herniation; Contraindications: 1, patients with disc herniation Patients with severe cardiac and renal insufficiency; 2. Patients with laxity of the posterior longitudinal ligament and lateral ligament and lumbar instability; 3. Patients with excessive osteophytes or severe calcification of the fibular ligament; 4. Patients with bleeding disorders; 5. Patients who are highly suspicious of this technique and unwilling to accept this surgery. Advantages: 1, the whole operation is completed under local anesthesia, the patient is awake throughout, avoiding the risk of anesthesia and reducing the chance of nerve root injury; 2, the patient’s skin incision is less than 1cm, with minimal trauma; 3, the vertebral plate is not removed, the paravertebral muscles and ligaments are not destroyed, there is little interference with the nerves and structures in the spinal canal, and the epidural fat is preserved, reducing intraoperative bleeding and the formation of scar tissue in the spinal canal after surgery, and reducing the 4.Short operation time, quick recovery after operation, shorten the hospitalization time, and reduce the economic burden of patients. 5, to avoid the recurrence of symptoms caused by tissue adhesion after open internal fixation; 6, compared with open surgery, the efficiency is comparable or even higher, and the risk and complications of re-operation are significantly higher in patients with poor results of open surgery; 7, the cost of surgery is 1/3 – 1/6 of the major open surgery, reducing the economic burden of patients. Case presentation I: Minimally invasive treatment of L4-5 disc herniation via lateral approach 57-year-old male, low back pain and pain radiating to the right lower limb for 8 years, has been treated by painkillers and massage physiotherapy with poor results, unable to walk today, pushed into the ward, MRI showed L4-5 disc degeneration and disc herniation, L5-S1 mild protrusion. Consideration: The patient is currently suffering from a herniated disc at L4-5, and the patient is old enough to undergo endoscopic removal of the herniated disc under local anesthesia. The surgical steps were as follows: 1. C-arm localization of the L4-5 puncture site 2. puncture and placement of the working trocar after localization 3. endoscopic nucleus pulposus removal of the stained herniated disc 4. removal of the herniated disc 5. band-aid coverage of the 1-cm-long incision The patient’s symptoms disappeared after the operation, and the MRI was reviewed at 1 year: no recurrence. Case presentation II: Target removal of giant disc herniation via posterior approach L4-5 Patient, male, 65 years old. He had pain in both lower extremities for two years, aggravated for 2.5 months, incontinence for 3 days. in January 2011, he had pain in the lumbar region with left lateral thigh and calf pain, which was treated with massage and massage at that time. in May 2012, the pain in the right lower extremity was significantly aggravated, walking was difficult, he had bilateral posterior lateral thigh and posterior calf pain, heavy on the right side, unable to stand, incontinence for the last 3 days, and numbness in the perineal region. Physical examination: carried into the ward, forced flexion position, muscle strength of both lower limbs grade 4, left straight leg raising test: 30 degrees; right straight leg raising test: 40 degrees. The anterolateral calf and lateral foot pain and temperature sensation were decreased. Lower abdominal pressure pain. 1.Preoperative forced flexion position of both lower limbs of the patient 2.Preoperative MRI showed L4-5 disc herniation (prolapse) 3.Minimally invasive treatment of disc herniation via posterior approach, puncture needle puncture. 4, Placement of working trocar and placement of endoscope. 5.Intraoperative C-arm fluoroscopy of trocar position. 6.Scopic observation of the herniated disc tissue and epidural fat. 7, Rotation of the working trocar and endoscope allows direct visualization of the nerve roots, ligamentum flavum and herniated disc tissue. 8, Removed disc tissue. 9, Postoperative review shows that the herniated disc was completely removed. 10.Postoperatively, the patient’s bilateral lower limbs movement was not affected, and the left lower limb straight leg elevation was 70 degrees. Fourteen days after surgery, the general condition was good, the diet and sleep were good, the body temperature was normal, the pain in the lumbar region and lower limbs disappeared, the numbness in the perineum disappeared, and the patient could defecate on his own, but he was still incontinent. Discussion: The patient has not recovered from urinary incontinence, considering that the compression of the nerve is long, even if the compression is lifted, some of the nerves are difficult to recover, so it is recommended that the patient should be treated promptly once the symptoms are present, and holding a fluke mentality will be irresponsible to his own body and also bring pain to his family. Case demonstration III: endoscopic lumbar 5-sacral 1 disc herniation removal 65-year-old male, left hip pain, radiating pain to the left lower extremity for 8 years, during the massage, medicine, physical therapy and other treatment, the effect is poor, to several hospitals recommended surgical removal + internal fixation treatment, the patient’s psychological burden, family members worried about the risk of surgery and larger treatment costs, has not been treated. The patient was introduced to our department for minimally invasive treatment by a friend, and with the patient’s consent, we now share our treatment experience with the patient in the hope that it will be helpful to patients in pain of herniated disc. 1. MRI at admission: lumbar 5-sacral 1 disc herniation, degeneration, deviation to the left side, left intervertebral foramen entrapment. 2, Intraoperative minimally invasive endoscopic display of herniated disc 3, Endoscopic nucleus pulposus removal of herniated disc 4, Minimally invasive incision at the end of the procedure Postoperative symptoms disappeared and the patient was discharged on foot 5 days later with no recurrence of pain at 1 year follow-up and the cost of the procedure was only 1/3 of that of open surgery. Summary The purpose of minimally invasive intervertebral foraminoscopic spine technique (non-discoscopic) is: to use intervertebral foraminoscopy outside the disc fibrous annulus, The purpose of minimally invasive spinal techniques (non-discoscopic) is to remove the herniated or prolapsed disc tissue and remove the hyperplastic bone spurs to relieve the nerve root compression and eliminate the pain caused by nerve compression. The procedure is performed through a minimally invasive spine surgery system consisting of a specially designed intervertebral foramoscope and corresponding minimally invasive spine surgery instruments, an imaging system, and a dual-frequency radiofrequency machine. While the herniated or prolapsed nucleus pulposus is completely removed, osteophytes are removed, spinal stenosis is treated, and the broken annulus fibrosus can be repaired using radiofrequency technology. The use of foraminoscopy allows for precise direct vision surgery of the disc without touching healthy tissue. Minimally invasive spine surgery is performed outside of the annulus fibrosus, thus maintaining the greatest degree of annular integrity and spinal stability, resulting in the least trauma and best results of any procedure of its kind. Minimally invasive foraminoscopic spine technology represents a new concept of minimally invasive spine surgery. It can perform herniated discs, foraminoplasty and fibular ring repair in all segments of the cervical and lumbar spine. The satisfactory outcome of the surgery can reach 85% – 90%. Because of its many advantages, foraminoscopy is now recognized as the leading minimally invasive procedure in international spine surgery, as is arthroscopy for herniated discs.