I. History, status quo and development direction of treatment of herniated disc (a) Limitations of traditional techniques Before the advent of interventional disc therapy, open surgery was the only effective means of treating severe disc herniation, and interventional therapy introduced a minimally invasive concept to the treatment of disc herniation. The currently available interventional methods include collagenase lysis, percutaneous excision and suction, laser vaporization (PLDD), plasma nucleoplasty, ozone, and radiofrequency ablation. However, all the above methods are indirect decompression, only for some cases of inclusive protrusion, cannot completely remove the diseased nucleus pulposus, especially the tissue compressing the nerve, cannot repair the broken fiber ring, and the necrotic tissue needs to be absorbed by the body naturally, which is long, painful and has a high recurrence rate. The development of posterior discoscopy in the mid-1990s has advanced the concept of minimally invasive surgery, and the majority of orthopedic surgeons gradually realized that with the emergence of new technologies and materials, minimally invasive technology is the direction of development of surgery. However, the surgical approach and treatment process of posterior discoscopy (MED) are consistent with small incision open surgery, which involves opening the lamina, stripping the muscles and ligaments, disturbing the spinal canal, and pulling the nerves (to a lesser extent than open surgery); it is prone to intraoperative bleeding, interferes with the visual field and increases the risk; it cannot be applied to the treatment of extreme lateral herniation and discogenic pain; and the postoperative scar tissue is prone to cause spinal canal and nerve Adhesions. The emergence of “intervertebral foraminoscopy” has overcome the shortcomings of the above-mentioned techniques and brought the minimally invasive treatment of disc herniation to a whole new level, which is currently the most minimally invasive, safe and economical technique; at the same time, this technique is still under rapid development and has been extensively applied to artificial disc and artificial nucleus pulposus replacement, foraminoscopic fusion and percutaneous techniques. The clinical efficacy and academic value of this technology have attracted more and more orthopedic surgeons to focus on the expansion of this technology. (2) Introduction of intervertebral foraminoscopy technology In cases of simple disc herniation and partial prolapse, the Out-in technique is used to enter the disc through the safety triangle, remove the diseased nucleus pulposus and then retreat outside the foramen to remove the prolapsed fragments; in cases of central type herniation and compression of the spinal canal beyond the line of the superior articular eminence, the distal lateral horizontal approach is used to directly remove the herniated tissue; in cases of free type, hypertrophy of the ligamentum flavum, calcification, spinal canal In cases of free type, ligamentum flavum hypertrophy, calcification, spinal canal stenosis, neural foraminal stenosis, etc., an intraforaminal approach is used to remove all kinds of diseased soft tissues and clean up the bone; spine surgeons are familiar with posterior surgery, so interlaminar approach can also be used in some cases, which is similar to MED, but with smaller openings and less interference with the spinal canal and nerves. (c) Summary of the advantages of intervertebral foraminoscopy technology: 1, minimally invasive Reach the target area through the lateral approach, avoiding interference with the spinal canal and nerves by traditional posterior surgery, without biting off the lamina, without destroying the paravertebral muscles and ligaments, and with no effect on spinal stability. 2.Direct purpose The surgical effect is consistent with the gold standard of disc surgery – microscopic discectomy; 3.Wide indications Can deal with almost all types of disc herniation, some spinal canal stenosis, foraminal stenosis, calcification and other bony lesions. The speculum makes scarring at the posterior important structures, causing adhesions of the spinal canal and nerves. 5, high safety local anesthesia, the operation can interact with the patient, not to hurt the nerves and blood vessels; basically no bleeding, clear surgical field of view, greatly reducing the risk of misuse; 6, fast recovery the next day after surgery can be down to the ground, the average of 3-6 weeks to resume normal work and physical exercise. 7.High patient satisfaction Immediate pain relief, self-care of urine and stool, simple care, oral antibiotics can be taken, feasible outpatient surgery; skin incision is only 7mm, in line with the aesthetic point of view. 8.Wide extension Combined with percutaneous fixation technology, the fusion and fixation of spinal slippage and instability can be completed in a minimally invasive manner; this basic platform can be easily extended to cervical disc endoscopic surgery. For cases of pure disc herniation, bulging or prolapse with severe neurogenic symptoms, the YESS technique is preferred to gradually retreat from within the disc to outside the intervertebral foramen; for cases of free type and combined with osteophytes and spinal stenosis, the Thessys technique is adopted directly to deal with free nucleus pulposus and bony structures by the intervertebral foramen route; this technical platform can deal with hypertrophy of the ligamentum flavum, stenosis of the lateral saphenous fossa and degenerative cases that are not suitable for open surgery in old age; nerve blocks and fibrous annuloplasty for discogenic lumbar and leg pain are feasible; with increased proficiency, it can be extended to endoscopic treatment of cervical spine diseases. The working channel can be used to place artificial discs, B-twin and bioengineering materials that are under development. The scope of adaptation and development prospects are extremely broad. In addition, the equipment configuration contains radiofrequency machine, which can be widely used in open surgery such as lumbar and diastasis tumors and intramedullary tumors with its many advantages of extremely low thermal damage, good hemostasis and pressure-free cutting, especially the cutting of fibrotic and calcified tissues is exceptionally fast and fine, and various sizes of needle and circle electrodes make the surgery with limited access easy. Third, the current situation at home and abroad In 1998, Dr. Anthony Yeung (President of American Minimally Invasive Science) pioneered YESS technology; in 2002, Professor Hoogland (former President of European Minimally Invasive Science) of Germany proposed THESSYS technology on the basis of YESS technology, which made intervertebral foraminoscopy technology mature, and under the continuous exploration and promotion of a large number of well-known experts and scholars in China intervertebral foraminoscopy technology has been developed significantly and has increasingly attracted great attention from domestic orthopedic colleagues. With the continuous development of new materials and technologies, this technology has an extremely attractive and broad development prospect. The advantage of foraminoscopic lumbar disc removal is that the entire procedure is done under local anesthesia, and the patient is awake throughout, avoiding the risk of anesthesia and reducing the chance of nerve root injury. The patient’s skin incision is less than 1 cm, which is minimally invasive. No removal of the vertebral plate, no destruction of the paravertebral muscles and ligaments, little interference with nerves and structures in the spinal canal, and preservation of epidural fat reduce intraoperative bleeding and the formation of scar tissue in the spinal canal after surgery, and reduce the possibility of postoperative vertebral instability. The operation time is short, the postoperative recovery is fast, the hospital stay is shortened, and the economic burden of the patient is reduced. It is reported that foraminoscopic lumbar disc removal requires a high level of operator knowledge of the anatomy of the lateral posterior foraminal region and basic percutaneous puncture and endoscopic techniques. Since the percutaneous puncture and positioning step is the focus and difficulty of the procedure, the operator often needs long-term clinical experience and good three-dimensional positioning ability to accurately and quickly reach the site of the herniated disc.