Objective To investigate the clinical efficacy and safety differences between unilateral biportal endoscopy (UBE) and percutaneous transforaminal endoscopic discectomy (PTED) in the treatment of paracentral lumbar disc herniation, and to provide a basis for the selection of clinical treatment plans. Methods A retrospective analysis was conducted on the clinical data of 88 patients with paracentral lumbar disc herniation admitted to Xinxiang Central Hospital from September 2021 to August 2024. According to preoperative doctor-patient communication and patient wishes, 42 cases underwent UBE surgery (UBE group) and 46 cases underwent PTED surgery (PTED group). Compare the two groups in terms of surgical time, incision length, intraoperative blood loss, postoperative hospital stay, incidence rate of complications, as well as the degree of back pain evaluated by visual analog scale (VAS) before surgery, 3 months after surgery, and at the final follow-up, and the degree of functional impairment measured by Oswestry Disability Index (ODI). Results All patients underwent smooth surgery and were followed up for 6 to 12 months postoperatively. The surgery time and incision length in the UBE group were higher than those in the PTED group, and the difference was statistically significant (all P <0.05). In the PTED group, there was a significant increase in the number of fluoroscopy procedures performed during surgery (P<0.05); There was no statistically significant difference between the two groups in terms of intraoperative bleeding loss, postoperative hospitalization stay, and incidence rate of complications (P>0.05). From 3 months after surgery until the last follow-up, both groups showed significant improvement in VAS and ODI scores compared to before surgery (all P <0.05). Conclusion Both UBE and PTED can effectively treat paracentral LDH, with significant postoperative pain relief and functional improvement. PTED has less trauma and faster postoperative recovery, making it suitable for patients with mild to moderate spinal stenosis; UBE is suitable for individuals with severe nerve compression who require sufficient decompression. The selection of surgical procedures should take into account the patient’s condition, imaging findings, and the doctor’s experience. This study provides a reference for the selection of surgical procedures for paracentral LDH.