ObjectiveTo investigate the clinical efficacy of uni-portal non-coaxial spinal endoscopic surgery combined with Polysorb 4-0 absorbable sutures for repairing ruptured annulus fibrosus in the treatment of lumbar disc herniation.MethodsWe conducted a retrospective study involving 201 patients who underwent uni-portal non-coaxial spinal endoscopic surgery from May 2023 to August 2024 at our institution. Among these patients, 22 were treated using ligamentum flavum suspension surgery while preserving the ligamentum flavum, combined with the annulus fibrosus suture technique. We analyzed the demographic information, preoperative and postoperative imaging data, and clinical outcomes of these 22 patients.ResultsThese 22 patients were followed for 6-15 months; at the last follow-up, the improvement in postoperative functional evaluations, such as the Oswestry Disability Index, was statistically significant (P < 0.05). There were two cases of epidural fibrosis at grade 1 and one case of epidural fibrosis at grade 2. There was a slight decrease in disk height. There were no instances of postoperative recurrence, although one patient exhibited postoperative dysesthesia.ConclusionUni-portal non-coaxial spinal endoscopic surgery is straightforward, versatile, and flexible. Preservation of the ligamentum flavum significantly helps prevent epidural fibrosis. Employing Polysorb 4-0 absorbable sutures to repair the annulus fibrosus reduces early recurrence risk, providing satisfactory outcomes for patients with herniated discs. This technique offers a novel and effective treatment alternative for lumbar disc herniation.