Minimally invasive ladder surgery for lumbar disc herniation

Lumbar disc herniation is a common and frequent disease causing lumbar and leg pain, and there are numerous treatment methods, including traditional Chinese medicine, medication, and surgery, but the overall efficacy is poor. With the emergence of minimally invasive spine technology and the maturation of discography technology, endoscopic technology has now gradually become a minimally invasive treatment for degenerative diseases of the lumbar spine. There is still a lack of uniform clinical understanding of the management of different stages of disc degeneration and surgical intervention. Modern lumbar disc herniation advocates a stepwise treatment method, i.e., different surgical methods are selected at different times according to the severity of the patient’s disc herniation and the location of the herniation. Therefore, it is necessary to standardize and unify the indications for each minimally invasive technique, so that the true “minimally invasive” technique can be used correctly and rationally to achieve maximum efficacy. In 1997, Anthony Yeung, a Chinese American, designed the Disc-FX system and used it in clinical practice. This technology is based on the development of the transvertebral foraminal YESS lateral posterior mirror technique, which is a new method of treating discogenic low back pain with X-ray fluoroscopic guidance for disc nucleus pulposus removal and radiofrequency ablation. He also developed the 3rd generation spinal endoscopy (Yeung endoscopy spine system (YESS), i.e. percutaneous transforaminal endoscopic discectomy (PTED), which is performed under local anesthesia, with minimal intraoperative trauma, minimal bleeding, and clear visualization. The technique is performed under local anesthesia, which is less invasive, less bleeding, and has the advantages of safety and less damage to the stability of the spine. It is widely used in the treatment of degenerative diseases of the lumbar spine in recent years because of its wide range of indications. Only a few large hospitals in China, such as Chongqing Xinqiao Hospital and 301 Hospital, have carried out more minimally invasive spine techniques, but the technical program is not comprehensive enough. In our department, all of the above minimally invasive techniques, namely ①Disc-FX system percutaneous discectomy and radiofrequency ablation. ②Posterior intervertebral discoscopic technique (MED). ③Posterior interlaminar endoscopic technique. ④Intervertebral foraminoscopic technique (PTED). ⑤ Minimally invasive decompression and fusion technique via Quadrant channel. ⑥minimally invasive extreme lateral approach lumbar interbody fusion (mini-XLIF or OLIF) ⑦percutaneous arch internal fixation technique is integrated so that it can be applied to different stages of disc degeneration to form a complete stepwise treatment plan. At present, the comprehensive treatment plan of applying all the minimally invasive technology systems to different patients with disc herniation has filled the gap in the province and is at the leading level in China, creating a new era of minimally invasive disc herniation treatment. At present, our department is equipped with minimally invasive equipment such as discoscope, foraminoscope and Quadrant minimally invasive channel, which is the earliest in the city to carry out minimally invasive spine technology and has the largest number of surgical cases, and is in the leading position in the city.