Percutaneous lumbar discectomy (PELD) is a minimally invasive surgical technique for the spine that has developed rapidly in recent years. It generally involves a posterior-lateral approach to access the disc through the foramen ovale’s “safety triangle”. This area is located on the posterior lateral aspect of the annulus fibrosus and allows safe passage of instruments without injury to the nearby traveling nerve roots. A water-mediated spinal endoscope, the laminoscope is a lighted tube that enters the intervertebral foramen from the side or back of the patient’s body and performs the procedure in the safe working triangle. The protruding nucleus pulposus, nerve roots, dural sac and proliferating bone tissue can be clearly visualized under direct endoscopic vision. Then various types of grasping forceps are used to remove the protruding tissues, microscopic removal of bone, radiofrequency electrodes to stop bleeding, and repair of the broken fibrous ring. Why is percutaneous lumbar discectomy less invasive? First of all, the skin incision of percutaneous lumbar discectomy is only 8mm, just like the size of a soybean grain, the wound is very small, which is more attractive to patients. From the doctor’s point of view, PELD starts with percutaneous fine-needle puncture, and after successful puncture, dilatation tubes are placed along the guidewire, and this kind of step-by-step dilatation operation causes very little damage to the muscles and very little bleeding; PELD does not need to resect a lot of normal bone, and only needs to enlarge the intervertebral foramen appropriately, which basically doesn’t affect the stability of the spine; the operation is performed in the ventral side of the nerve root, which causes little interference with the nerve root and the venous plexus of the spinal canal and little postoperative neural adhesion. The surgery is performed on the ventral side of the nerve root, with little interference to the nerve root and the venous plexus in the spinal canal, and the postoperative nerve adhesion is relatively small; the bleeding is generally very small, mostly less than 20 ml, and the overall trauma is significantly reduced. Another important aspect is that this procedure can be performed under local anesthesia, avoiding general anesthesia and reducing interference with systemic organs. PELD is of great importance as this procedure simply removes the herniated disc without stapling, avoiding spinal fusion and preserving the motor function of the spine. Why is recovery faster with percutaneous lumbar discectomy? As mentioned above, because of the overall low trauma, low bleeding and local anesthesia operation, the patient’s recovery is much faster than open surgery. Since it is a local anesthesia procedure, theoretically the patient can get down to the floor immediately, but we do not recommend being so active in order to minimize the chance of disc recurrence. Overseas, this surgery is usually a day surgery and the patient can be discharged the same day after 6-8 hours of observation. Our experience is that you can usually get down to the ground on the first day after surgery, and gradually increase your activity by moving around for 3-4 weeks under the protection of a brace, so that the chance of recurrence can be minimized by such a prudent approach. You can return to normal work and life about 1 month after surgery. Generally, 1 month after surgery, posterior posterolateral percutaneous discectomy can be performed under local anesthesia so that the surgeon can obtain direct feedback from the patient when placing the working channel to avoid damage to the nerve root. Why is percutaneous lumbar discectomy so effective? The greatest advantage of percutaneous discectomy is that it is a direct vision procedure, where the herniated disc and the corresponding nerve root can be visualized and the nerve root can be adequately decompressed under direct vision, rather than indirectly decompressed, which would have been less effective in the past. In addition, it is possible to verify the relief of low back and leg pain by examining the straight leg raising test immediately after surgery. Although percutaneous lumbar discectomy has many of the advantages mentioned above, the most important thing is to choose the right case, and only by choosing the surgical indications can we truly bring the gospel to patients with lumbar disc herniation through minimally invasive spinal techniques. Figure 1: Male, 24 years old, with lumbar pain accompanied by radiating pain and numbness in the left lower limb for half a year, with poor results of conservative treatment. Lumbar MRI and CT suggested L4-5 disc herniation (prolapse type). Figure 2: The large piece of nucleus pulposus tissue removed during the operation. In the intraoperative microscopic image, the middle white color is the nerve root, which became flaccid after the removal of the prolapsed nucleus pulposus tissue. Figure 3: The left straight leg elevation was only 30 degrees before the operation, but it could be elevated 70-80 degrees after the operation, which is very intuitive to show the efficacy of the operation.