The Department of Pain Medicine has successfully performed C-arm X-ray guided percutaneous lumbar disc removal using a third generation laminar foraminoscope (maxmore foraminoscope) in three patients within one week with excellent clinical results. The traditional treatment for lumbar disc herniation is a posterior median approach incision, which is relatively traumatic because the paravertebral muscles have to be removed from the spine and general anesthesia is required. In contrast, foraminoscopy uses a posterior lateral foraminal approach, which avoids muscle stripping, and the operation is performed under local anesthesia, allowing communication with the patient throughout the operation and observation of changes in the patient’s symptoms at all times. Even if a nerve root is encountered, the drill will squeeze it to one side, greatly reducing the possibility of damaging the nerve root. Knowledge Base: Intervertebral foraminoscopy and its indications Intervertebral foraminoscopy is one of the many minimally invasive spine surgery techniques that have emerged in recent years. Under endoscopic surveillance, the herniated disc is removed through a foraminal approach, reducing interference with the muscles, epidural space, and nerve tissue, and recovery is relatively rapid after surgery. Anesthesia: local anesthesia, and the operator can communicate with the patient throughout the operation, avoiding possible nerve damage. Surgical time: The entire surgical operation takes about 2.0 hours, and the patient adopts a lateral position on the operating table, which is more easily tolerated than a prone position. Postoperative recovery: Because the procedure avoids muscle stripping and does not destabilize the segment, the patient can generally move around immediately after surgery without wearing a peri-waist. Oral pain medication and nerve nutrition medication are required for 2 weeks after surgery to speed up the recovery of nerve function. Cost of surgery: Under normal circumstances, the hospitalization cost for the entire hospitalization period is about 20,000-25,000 RMB. Period of hospitalization: The period of hospitalization for lumbar disc herniation treated by foraminoscopy is between 3-4 days, and the patient is usually discharged on the 1st day after surgery. Optimal indications: (1) For adolescent disc herniation and disc herniation in younger patients, the foraminoscopic technique has the characteristics of small surgical scars, prevention of further instability of the spinal motion segments, and prevention of scarring in the spinal canal to provide space for possible secondary surgery. (2) Geriatric disc herniation: elderly patients have many comorbidities and have difficulty tolerating general anesthesia. The foraminoscopic technique uses surgery under local anesthesia, which reduces the interference with the body’s internal environment and facilitates postoperative recovery. Figure 1 The surgical incision is about 17.5 px. Figure 2. The blue-stained herniated disc nucleus pulposus removed during the operation. Figure 3. The third-generation intervertebral foraminoscope in operation. Figure 4. After the completion of the microscopic decompression, the nerve root surface was filled with blood vessels, the nerve root mobility was good, and the patient’s symptoms were relieved immediately.