Minimally invasive intervertebral foraminoscopic spine technique (percutaneous spinal endoscopy) Minimally invasive intervertebral foraminoscopic spine technique represents a new concept of minimally invasive spine surgery. Also known as percutaneous spinal endoscopy, it can perform disc herniation, foraminoplasty and fibrous ring repair in all segments from the cervical spine to lumbar 5 sacral 1. The satisfactory outcome of the surgery can reach 85-90%. Because of its many advantages, foraminotomy is now recognized as the dominant procedure in the field of international spine surgery. The surgical approach is a minimally invasive spine surgical system consisting of a specially designed foraminoscope with corresponding minimally invasive spine surgical instruments, imaging and image processing system, holmium laser and ellman dual frequency radiofrequency machine. While completely removing the herniated or prolapsed nucleus pulposus, it removes osteophytes, treats spinal stenosis, and can repair the broken annulus fibrosus using radiofrequency technology. Because minimally invasive spine techniques are performed outside of the annulus fibrosus, the use of foraminotomy allows for precise surgery of the disc without touching healthy tissue. As a result, the integrity of the annulus fibrosus is maintained to the greatest extent possible and the stability of the spine is preserved, resulting in the least traumatic and most effective patient outcome of any procedure of its kind. Superiority of minimally invasive intervertebral foraminoscopic spine technique The minimally invasive intervertebral foraminoscopic spine technique is a well-established and mature technique with the following major advantages: 1. The patient requires only local anesthesia, not general anesthesia. The surgery is done while the patient is completely awake. The patient’s reaction can be detected at any time during the surgery. 2. The surgical site is reached through a very small percutaneous incision, minimizing the risk of infection during and after surgery. 3.Unlike traditional surgical techniques, the foraminal approach does not require partial removal of the intervertebral ligaments (ligamentum flavum), conus or intervertebral joints (conus laminectomy). It also does not require cutting the trunk muscles, increasing postoperative stability and reducing trauma and pain. 4. Recovery after surgery is fast, and the patient can leave the hospital in 1-3 days after surgery. Patients can return to work and ensure a high quality of life as soon as possible. 5.The unique design of cannula and surgical instruments can find and protect the nerve roots, protect the epidural and perineural venous system, prevent venous stasis and chronic neuroedema. This reduces the formation of perineural and epidural scarring. It will not damage the good dura and nerve ligament structure and reduce the occurrence of nerve root tethering. 6.The use of working cannula can reduce the injury of paravertebral muscles and loss of innervation. The stripping and stretching of the paravertebral muscles in open surgery often damage the paravertebral muscles and make the muscles lose innervation. In addition, postoperative segmental instability and slippage can be prevented. For accommodative disc herniation, intra-vertebral disc surgery decompression surgery protects the integrity of the posterior annulus fibrosus and posterior longitudinal ligament, thereby reducing the chance of recurrence of postoperative disc herniation. Examination for minimally invasive intervertebral spine surgery To precisely determine the location and nature of the herniated or prolapsed nucleus pulposus, as well as intervertebral foraminal osteophytes, a thorough clinical and imaging examination is performed prior to surgery, especially CT and MRI are important to precisely determine the size, location, and nature of the nucleus pulposus. The final diagnosis is confirmed by discography. Appropriate patient positioning and precise design of the disc approach from the skin to the herniated disc are essential to obtain a good surgical outcome. The lateral or prone position can be chosen depending on the location and nature of the herniated or prolapsed nucleus pulposus. Indications for minimally invasive interbody spine surgery THESSYS can be used for any minimally invasive procedure for herniated discs. All prolapsed and bulging disc material (including the 5th lumbar and 1st sacral intervertebral spaces) can be removed using the entire system under local anesthesia through the lateral foramina. The use of the entire system is indicated for any patient with nerve root symptoms or chronic pain caused by herniated discs or larger bony herniations that do not improve with conservative treatment. Cauda equina syndrome represents an indication for immediate surgery. Published international literature reports success rates of more than 90% at 1 and 2 years postoperative follow-up, with early recurrence rates of less than 5%. In cases of recurrent disc herniation, the success rate exceeds 85%.