”Minimally invasive surgery”, as the name implies, means tiny trauma. Laparoscopy in general surgery gynecology and thoracoscopy in thoracic surgery have largely replaced open abdominal and open chest surgery. In joint surgery, arthroscopy has also greatly reduced the trauma of joint surgery. In fact, the concept of minimally invasive spine has existed for nearly 50 years, and the first case of papain application for lumbar disc herniation was reported in the United States in 1963, which was the beginning of minimally invasive spine surgery. The principle of papain-based nucleolysis for lumbar disc herniation is that a fine needle is inserted into the diseased disc and injected with papain to liquefy the nucleus pulposus tissue within the disc, thus creating negative pressure within the closed disc and “sucking” the herniated disc back. In other words, nucleolysis does not directly “dissolve” the herniated disc, but indirectly allows the herniated disc to return to the intervertebral space through the formation of negative pressure within the disc. Therefore, it is important that the outer surface of the disc does not rupture, so that negative pressure can be created in the intervertebral space. Therefore, a prolapsed disc is not suitable for nucleolysis. Many patients interpret nucleolysis as an injection of a drug to digest the protruding disc, knowing that the protruding disc and the surrounding nerves are in close proximity to each other. Therefore, the biggest problem with this treatment is that in case the drug leaks into the spinal canal it can cause serious nerve damage, which is chemical damage that is very difficult to remedy. Because of this the incidence of side effects is quite high. The subsequent development of radiofrequency ablation and the ozone disc ablation surgery carried out in recent years in some hospitals in China are based on the above-mentioned principle, that is, the principle of indirect decompression. The condition is that the herniated disc is not large and the outer annulus fibrosus is not ruptured. There is no spinal stenosis, etc. In other words, this type of treatment is only suitable for patients with early, mild disc herniation. According to the current professional literature and the results of conferences, they have an average therapeutic effect. The reason for this may be related to the fact that the indications were not strictly controlled, and many patients who should not have been done were done, with poor results. I know that many patients with herniated discs desire to have no surgery, or a minor surgery to relieve their symptoms, but it is important not to have a disease. Intervertebral discoscopy. It is performed with the help of an auxiliary light source, a magnifying glass or microscope, or a television-assisted system that operates through a tiny channel for disc removal. This approach maximizes the protection of the paravertebral muscle tissue and has a small skin incision, resulting in less surgical damage and faster postoperative recovery. It is suitable for patients with herniated discs or more limited spinal stenosis. The problems with this type of surgery are that the surgery is performed through a very small tube, the surgical field of view is small and poor, the television assist system is a two-dimensional image, not a three-dimensional image also makes the surgery difficult, the surgical instruments are very long and difficult to operate, therefore, this type of surgery must be operated by a very experienced surgeon who specializes in discoscopy. Otherwise, there will be more complications such as intraoperative nerve damage and incomplete resection. Because of the narrow indications for this type of surgery and the special training required to perform it, there are only a few well-known spine surgeons in large hospitals who use this type of surgery. At the same time, this type of surgery can be accomplished in many cases by simple open discectomy. The trauma is not significant. Percutaneous pedicle screw fixation techniques and percutaneous access techniques. This type of surgery also minimizes surgical trauma by avoiding stripping of the paravertebral muscles to the greatest extent possible. At the same time, their application is more extensive. It can treat huge lumbar disc herniation or prolapse, lumbar spinal stenosis, scoliosis deformity, spinal tumor, tuberculosis, etc. Thanks to the more advanced percutaneous access technology, the surgical field of view is wider than that of discoscopy, and conventional surgical instruments can be applied, which is relatively easy for the surgeon to master. The percutaneous pedicle screw fixation system is done under the guidance of intraoperative fluoroscopy, which is less invasive and more precise. Therefore, this type of surgery is the more mainstream minimally invasive surgical approach at home and abroad. The problem is that the operation of percutaneous screw fixation requires repeated fluoroscopy, which inevitably increases radiation exposure to the surgeon and the patient. Among other things, the damage to the surgeon is greater. In my personal experience, I have treated cases of lumbar disc herniation, lumbar spinal stenosis and metastatic spinal cancer with this approach, and the general postoperative response of patients is less pain, less postoperative drainage, early discharge from the hospital. Overall, minimally invasive surgery is a large class of surgical procedures and is a surgical technique. Which surgical modality is appropriate for the patient depends most on which modality the disease needs to be addressed, and secondly, which surgical modality the attending surgeon is familiar with. It should be said that the traditional surgical approach is the one that has been proven for decades and has the most definite results. The minimally invasive surgical approach is a new technology that has been developed in recent years. After all, new technology has its limitations and needs to be tested by time.