<p>To assess the value of contrast-enhanced lumbar MRI in guiding the selection of surgical approaches for recurrent lumbar disc herniation (RLDH) treated with full-endoscopic surgery. Clinical data were retrospectively analyzed from 237 patients with RLDH who underwent preoperative contrast-enhanced lumbar MRI. Surgical approaches were selected based on the location and degree of nucleus pulposus extrusion observed on MRI. The disc levels involved were as follows: L2/3 (1 case), L3/4 (11 cases), L4/5 (111 cases), and L5/S1 (114 cases). Surgical duration, intraoperative blood loss, length of hospital stays, and surgical complications were recorded. Clinical outcomes were evaluated using the Oswestry Disability Index (ODI) and visual analog scale (VAS) scores for low back and leg pain. All patients successfully underwent full-endoscopic discectomy. At one month postoperatively and at the final follow-up, VAS and ODI scores showed significant improvement compared to preoperative values (final follow-up vs. preoperative: lower back pain VAS [0.34 ± 0.50 vs. 2.54 ± 1.82], leg pain VAS [0.06 ± 0.29 vs. 5.53 ± 1.65], and ODI [0.51 ± 0.98 vs. 66.08 ± 47.14]). According to the modified MacNab criteria, outcomes were rated as excellent in 195 cases, good in 35, fair in 5, and poor in 2, yielding an excellent-to-good rate of 97.0%. No serious intraoperative, postoperative, or follow-up complications were observed. Contrast-enhanced lumbar MRI provides clear visualization of intraspinal anatomical structures in patients with RLDH, facilitating accurate preoperative determination of decompression boundaries. By assessing the spatial relationship between the reherniated nucleus pulposus and the pedicle, and incorporating iliac crest height and surgical history, the optimal surgical approach can be selected. This enables safe and effective removal of herniated disc material, adequate nerve root decompression, and favorable clinical outcomes.</p>