Low back pain is common in China, and there are few adults who have not suffered from low back pain. Some people come to the hospital with severe low back pain or with radiating pain in the lower extremities, and after a series of examinations, it is found that the lumbar disc herniation is huge and needs surgery, and then they face the problem of choosing the surgery method: open surgery? Discoscopic surgery? Intervertebral foraminoscopy? What is the difference between them? In order to figure out the difference between them, it is necessary to know how the respective surgery is done: In general, open surgery means that a 3-5 cm skin incision is made at the corresponding surgical site on the back, followed by a deep cut into the back muscles to reveal the vertebral plate, and then a small window is bitten into the plate with a special instrument to reveal the spinal canal and nerves, followed by going in and pulling the nerves apart to reveal the herniated disc below. The nerve is then distracted to reveal the herniated disc underneath, the disc is then removed, and finally the tissue is sutured layer by layer to end the surgery. The entire procedure is performed under continuous epidural (hemi-anesthesia) or general anesthesia. Discoscopic surgery is actually a scaled-down version of open surgery. It requires only a 2 cm incision, then a working tube is placed on the surface of the vertebral plate. The subsequent steps are the same as in open surgery: opening of the vertebral plate – distraction of the nerve – removal of the disc – – suturing of the tissue – end of the procedure. -suturing the tissue – ending the procedure. The entire procedure is also performed under continuous epidural anesthesia (hemi-anesthesia) or general anesthesia. There are two approaches to laminectomy, one from the lateral aspect of the back and one, like discoscopy, from the posterior aspect of the back. Either way, the herniated disc is accessed directly by puncture, a working canal is gradually established, and through this working canal, which is approximately 0.7 cm in diameter, a coaxial endoscope is placed to observe the situation in the spinal canal under direct endoscopic vision and remove the herniated disc tissue. Since the working tube is only 0.7 cm in diameter, the surgical incision is only about 0.7 cm, which basically protects all the tissues outside the disc and minimizes additional damage to the body. The entire procedure can be performed under local anesthesia. For the above three surgical methods, they can be briefly summarized as follows (of course not applicable to all cases): 1. Open surgery can basically be replaced by discoscopic surgery. Because the two principles are the same, and the latter is less traumatic. 2, if you can choose foraminoscopic surgery, do not choose discoscopic surgery. Because the damage of foraminoscopic surgery is much less than discoscopic surgery, many patients can immediately disappear the pain and walk on the ground after surgery, which can rarely be achieved after discoscopic surgery. Not every patient with disc herniation can undergo foraminoscopic surgery, and some patients with herniation with calcification or severe stenosis of the lumbar spinal canal are not suitable. The specific situation needs to be judged by the doctor. 4, open surgery and discoscopic surgery can remove part of the disc that has not yet herniated, which reduces the probability of re-herniation of the disc. Because of the small size of the canal, it is difficult to remove both the herniated disc and the unherniated disc, so the recurrence rate of herniation should be slightly higher than that of open surgery and discoscopic surgery. That said, the disc has an important physiological function, and removing more will lead to accelerated narrowing of the intervertebral space and premature aging of the lumbar spine, which is the root cause of many age-related back pains. Therefore, the medical community has not yet decided whether to cut the unprotruded discs or not, and how much to cut. I think the ideal situation is to cut out the disc that is protruding and compressing the nerve, and to keep the disc that is not compressing the nerve (even if it may appear as a slight protrusion in morphology). However, this is only the ideal and cannot be perfectly achieved in reality. After summarizing what has been said, my personal opinion is to try to solve the problem in the least invasive way possible. No intervertebral foraminoscopy, no discoscopy, no open surgery. If the herniated disc that causes the symptoms is cut, if it is cured, that is the best result; if it recurs, then the least invasive method of surgery is chosen again (the more minimally invasive the surgery, the less impact on the human body when repeated) and the possibility of recovery is still high; if it is not effective, then the surgery is upgraded to a more invasive one until the corresponding good results are achieved.