Abstract: Objective To explore the effectiveness of percutaneous transforaminal endoscopy on patients with extreme lateral lumbar disc herniation (LDH). Methods A total of 60 patients with extreme lateral LDH in the Traditional Chinese Medicine Hospital of Bazhong were selected. According to the random number table method, they were divided into two groups (n=30): a control group and an observation group. The control group received routine laminectomy and discectomy, while the study group underwent percutaneous foraminal endoscopic discectomy. Both groups were compared for intraoperative blood loss, operation time, the length of hospitalization stay, magnetic resonance imaging (MRI) parameters of lumbar spine before and after operation, VAS score, and lumbar spine function (JOA) score, the Lindblon grade of the nerve roots, lower limb nerve conduction velocity and the excellent and good rates of therapeutic effects were compared between the two groups. Results The study group showed less blood loss and shorter length of hospitalization stay than the control group (P<0.05). Six months after operation, the study group presented decreases in VAS scores, increases in JOA scores, lower limb nerve conduction velocity and the excellent and good rates of therapeutic effect, and improvement in Lindblon grades of the nerve roots and MRI lumbar imaging parameters, compared with the control group (P<0.05). Conclusions Treatment of extreme lateral LDH with percutaneous transforaminal endoscopy can improve MRI lumbar spine imaging parameters and lower limb nerve transmission, relieve lumbar and leg pain, and improve lumbar spine function, with significant effects.