Full-Endoscopic Isolation Zone Technique for the Treatment of Lumbar Disc Herniation

Begin with a patient diagnosed with lumbar disc herniation, in which the nucleus pulposus of the intervertebral disc in the lower spine protrudes through a torn annulus fibrosus.

This compresses nearby spinal nerves, causing pain.

The patient is locally anesthetized at the surgical site, and a working channel is inserted through the opening between two adjacent vertebrae, reaching the herniated disc.

Insert a spinal endoscope through the channel to visualize the area.

Using endoscopic forceps, remove the inflamed soft tissue from the spinal canal.

Next, excise the degenerated and ruptured annulus fibrosus and the protruding pulposus.

This creates an isolation zone—a surgically cleared area around the nerve that relieves nerve

pressure and blocks pain signals.

Apply radiofrequency to stop bleeding in the affected disc and to shrink the tissue.

Spontaneous nerve pulsation confirms successful decompression.

Withdraw the instruments, then suture the incision.

Place a 7.5 millimeter diameter spinal endoscope with a 3.7 millimeter diameter working channel at the lumbar disc herniation to explore and clean the ligaments and the residual bone fragments in the intervertebral foramen area, the soft tissues in the spinal canal and the protruding lumbar intervertebral disc.

Remove the proliferated inflamed soft red tissues scattered in the vertebral canal with microscopic surgical instruments. Use nucleus pulposus forceps to explore the torn area of the annulus fibrosis and remove the severely degenerated and inelastic tissue. Then use miniature surgical forceps to remove the ruptured part of the annulus fibrosis and the protruding nucleus pulposus.

Use flexible bi-polar radio frequency to coagulate the annulus fibrosis and the nucleus pulposus to stop the bleeding, shrink, and denervate them. When there is enough space around the nerve root and the dural sac during the operation, use flexible bipolar radiofrequency to perform an annuloplasty and nucleoplasty on the residual annulus fibrosis and nucleus pulposus, respectively. Explore the nerve root with a miniature probe hook to ensure sufficient space and spontaneous pulsation.

Remove the endoscope and its working channel, and suture the skin with a 4-0 nonabsorbent surgical thread suture.