Objective <p>To compare the short-term clinical efficacy of percutaneous endoscopic transforaminal discectomy (PETD) with that of unilateral biportal endoscopy (UBE) in the treatment of upper lumbar disc herniation (ULDH).</p> Methods <p>Clinical data from 109 consecutive hospitalized patients who were diagnosed with ULDH and admitted to the Department of Orthopaedics, The First Affiliated Hospital of Zhengzhou University, from February 2021 to February 2024 were retrospectively analysed. The patients were divided into two groups on the basis of the surgical approach: the PETD group (<i>n</i> = 58) and the UBE group (<i>n</i> = 51). Perioperative and follow-up indicators, including operation time, intraoperative blood loss, postoperative bed rest duration, postoperative hospital stay, postoperative complication rates, Oswestry Disability Index (ODI) scores, and Visual Analogue Scale (VAS) scores for low back and leg pain (assessed preoperatively and at 3 days, 3 months, and 6 months postoperatively), were compared. Additionally, the recurrence rate and excellent/good efficacy rate (evaluated via the modified MacNab criteria) were recorded at 12 months postoperatively. For imaging evaluation, lumbar MRI was used to assess changes in the dural sac cross-sectional area (DSCA) at the operated segment preoperatively and 6 months postoperatively.</p> Results <p>No statistically significant differences were observed between the two groups in terms of operation time or intraoperative blood loss (<i>P</i> &gt; 0.05). In both groups, the VAS scores for low back and leg pain and the ODI scores at 3 days, 3 months, and 6 months after surgery were significantly lower than those before surgery (<i>P</i> &lt; 0.05); however, the intergroup differences in these scores at each time point were not statistically significant (<i>P</i> &gt; 0.05). There were also no significant differences between the two groups in terms of the 12-month postoperative excellent/good efficacy rate or recurrence rate (<i>P</i> &gt; 0.05). Regarding imaging results, both groups showed a significant increase in DSCA compared to preoperative values (<i>P</i> &lt; 0.05), and no significant difference was found between the PETD and UBE groups (<i>P</i> &gt; 0.05). Notably, compared with the UBE group, the PETD group had a shorter postoperative bed rest duration and hospital stay (<i>P</i> &lt; 0.05). The overall incidence of postoperative complications was significantly lower in the PETD group than in the UBE group (5.17% vs. 21.17%, <i>P</i> &lt; 0.05). In particular, the incidence of nerve injury (especially transient nerve injury) was also significantly lower in the PETD group (<i>P</i> &lt; 0.05).</p> Conclusion <p>Both PETD and UBE are effective for the short-term treatment of ULDH. Nevertheless, PETD offers advantages, including a lower incidence of postoperative complications (especially transient nerve injury), minimal intraoperative trauma, earlier postoperative ambulation, and a reduced duration of postoperative bed rest and hospital stay.</p>