Purpose To analyze the clinical efficacy of arthroscopic-assisted uni-portal spinal surgery (AUSS) in the treatment of far lateral lumbar disc herniation (FLLDH). Methods A retrospective analysis was conducted on 120 cases of FLLDH patients. The patients were divided into two groups based on the treatment methods: the control group (CG, n = 68) underwent percutaneous endoscopic lumbar discectomy (PELD), while the study group (SG, n = 52) received nucleus pulposus removal under the AUSS technique. Perioperative indicators, 6-month postoperative efficacy rate, and postoperative complications were collected and compared between the two groups. Additionally, preoperative and postoperative patient assessments included pain levels [Visual Analogue Scale (VAS)], Oswestry Disability Index (ODI), Japanese Orthopaedic Association (JOA) score and lumbar mobility. Results Compared to the CG, the SG demonstrated a shorter operative time, as well as reduced time to ambulation and postoperative hospital stay (P < 0.05), while there was no statistically significant difference in intraoperative blood loss between the two groups (P > 0.05). The overall efficacy rate at 6 months postoperatively in the SG (94.23%) was higher than that in the CG (79.41%) (P < 0.05). The incidence of postoperative complications in the SG (5.77%) was lower than that in the CG (19.12%) (P < 0.05). At 3 and 6 months postoperatively, the SG showed lower VAS and ODI scores and higher JOA scores than the CG (P < 0.05). The ranges of motion for left lateral bending, flexion, extension, and right lateral bending of the SG were greater than those of the CG at 3 and 6 months postoperatively (P < 0.05). Conclusion The AUSS technique demonstrates superior efficacy over PELD in the treatment of FLLDH, effectively alleviating pain, enhancing functional outcomes, and improving quality of life, with a lower incidence of complications. Its minimally invasive nature and remarkable recovery efficiency highlight its promising clinical potential, warranting further validation of long-term outcomes through prospective follow-up studies.