Lumbar disc herniation is a common spinal disorder primarily characterized by low back pain, sciatica, and neurological deficits, which severely affects patients' quality of life. Surgical treatment is usually indicated for patients who do not respond to conservative management. However, some patients still experience recurrent pain in the lower back and lower extremities after surgery, which is partially attributed to postoperative epidural fibrosis leading to lumbar surgery failure syndrome. The ligamentum flavum is a natural anatomical structure of the spine, and its preservation during surgery can reduce postoperative scar tissue formation and recurrent lumbocrural pain. With the development of minimally invasive techniques, ligamentum flavum preservation under spinal endoscopy has been increasingly applied in the treatment of lumbar disc herniation. Uni⁃portal non⁃coaxial spinal endoscopic surgery (UNSES), also known as endoscope⁃assisted uni⁃portal spinal surgery, is a novel technique that, when combined with ligamentum flavum preservation, has demonstrated favorable clinical effects and safety in the treatment of lumbar disc herniation and related disorders. Based on this, this paper reviews the current status of research on ligamentum flavum preservation technique and its combined application with UNSES.

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