Intervertebral foramen mirror: Percutaneous endoscopic discectomy (PELD) is to take out the protruding intervertebral disc tissue through the intervertebral foramen or "safety triangle" through a posterolateral approach with a set of special equipment and instruments, so as to relieve the pressure and release the dural sac and nerve roots. PELD generally uses local anesthesia. It can effectively avoid the injury to nerve roots during operation, and take out the protruding or herniated intervertebral disc under the direct vision of endoscope. Because the operation is carried out under local anesthesia, the patient is awake and can quickly feed back the pain feeling during the operation to the doctor, thus ensuring the safety of the operation. PELD does not need to remove the ligamentum flavum and lamina while removing the protruding intervertebral disc tissue, and does not destroy the posterior stability of the spine. Compared with MED or open surgery, Peld has less injury and is more in line with the concept of minimally invasive treatment of spine. Stenosis of intervertebral space, spinal instability or spondylolisthesis should be considered as contraindications of this treatment technique. If the iliac crest is high, it will bring great difficulties to the treatment of L5-S 1 disc herniation. It is suitable for low back pain and radiation pain as the first complaint, and there is no history of open operation of lumbar intervertebral disc, and all of them are single-segment protrusion; Young and middle-aged patients with poor curative effect or worsening symptoms after conservative treatment. The main positive signs of clinical examination are positive straight leg elevation test and weak muscle strength of extensor dorsi pedis.
Endoscopy of intervertebral disc: MED surgery should be suitable for LDH patients of different ages, just like traditional surgery. However, due to the small window and limited visual field, the treatment of intraspinal complications is much more difficult than traditional open surgery. Therefore, LDH in the elderly has a long course of disease and repeated treatment, especially those who have received nucleolysis, severe spinal stenosis, lumbar spondylolisthesis, recurrent LDH and so on. It should be listed as a contraindication for medical surgery.
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