Lumbar disc herniation is the most common cause of low back pain, and about 10-15% of patients eventually require surgery. 1934 M zxter and Barr reported on lumbar disc herniation and its surgical results, and since then, surgical treatment of lumbar disc herniation has occupied a very important position in spinal surgery. Traditional open surgery such as total laminectomy, hemilartebral laminectomy, and laminotomy for disc nucleus pulposus removal is very traumatic, with an incision of more than 10 cm and extensive stripping of the paravertebral muscles, biting off the lamina and part of the articular eminence, destroying the posterior column structure of the spine and leading to lumbar instability and long-term lower back pain after surgery. The microendoscopic lumbar discectomy (MED) is one of the minimally invasive spine procedures that have emerged in recent years to address the patient’s condition while minimizing adjacent tissue, reducing trauma, and shortening the recovery period, and is now widely used. The MED system was first introduced to enable spine surgeons to decompress lumbar nerve roots through a minimally invasive discoscopic approach. The surgical approach is the same posterior approach as traditional lumbar disc removal and microdiscectomy. The endoscope and surgical instruments are introduced directly through the 16mm working tube, and a window is made directly between the ligamentum flavum and the upper and lower laminae to remove the herniated disc tissue. By changing direct vision into observation on the monitor, the operator can easily identify various tissues and clearly understand the relationship between the dural sac, nerve roots and the herniated disc through the clear and magnified images on the surveillance system, which can completely resolve the nerve root compression while avoiding damage to the nerve roots and dural sac and can completely stop bleeding; reduce the incision to about 16 mm, limit the stripping of the paraspinal muscles to one side of the spinous process, do not extensively strip the paraspinal muscles, and only The incision is reduced to about 16 mm, the paraspinal muscle stripping is limited to the spinous process side, the paraspinal muscles are not extensively stripped, and only a small amount of the lower edge of the vertebral plate is bitten off to enlarge the gap between the vertebral plate, which completely preserves the middle and posterior spinal column structure and does not interfere with the normal spinal biomechanical structure, which does not affect the stability of the lower lumbar spine after surgery and reduces the incidence of complications such as postoperative spinal slippage and lower back pain. MED indications and complications Indications: 1. disc herniation, regular conservative treatment for 6 weeks is ineffective. 2. single-segment or two-segment spinal stenosis. Complications: low incidence, most common are dural tear and nerve root injury, followed by bleeding and hematoma formation. Clinical comparison between MED system and traditional open surgery The technology is essentially the same as that of open surgery, and the operations such as partial resection of the ligamentum flavum, lamina and articular eminence, enlargement of the nerve root canal, release of adhesions around the nerve root, and removal of the intervertebral disc can be done under the microscope, making the open surgery minimally invasive and endoscopic. It was found that during open lumbar spine surgery, the paravertebral muscles are stretched for a long time due to the need to expose a large surgical field, which can lead to a significant decrease in intramuscular perfusion pressure or even zero, and eventually lead to ischemic damage to the paravertebral muscles, which has a certain correlation with postoperative lower back pain. In contrast, MED surgery is performed in a small space, and the working tube is only 1.6 cm in diameter, so the pressure on the surrounding tissues is minimal. Advantages: 1, small trauma, skin incision 1.6CM. 2, small muscle stripping; no postoperative lumbar muscle muscle atrophy, postoperative back pain, low incidence of lumbar stiffness; 3, little bleeding, fast recovery; 4, clear intraoperative field of view, tissue into a clear, not easy to damage the nerve; 5, high postoperative excellent rate, about 90% or more; 6, does not destroy the stability of the spine, no internal fixation; 7, low cost.