Lumbar disc herniation (LDH) is a prevalent spinal disorder affecting 20–40% of the population. This study compared the clinical efficacy of two minimally invasive techniques, one-hole split endoscopy (OSE) and unilateral biportal endoscopy (UBE), for treating single-level LDH. A retrospective analysis of 217 patients (OSE: 118; UBE: 99) treated between April 2021 and January 2025 demonstrated that while both techniques were effective, OSE offered several advantages. Incision lengths were shorter in the OSE group (2.20 ± 0.33 cm vs. 2.91 ± 0.33 cm; p < 0.001), and fewer intraoperative fluoroscopy sessions were required (2.05 ± 0.21 vs. 2.59 ± 0.59; p < 0.001). Postoperative assessments revealed lower Oswestry Disability Index(ODI) scores (19.40 ± 2.81 vs. 20.87 ± 2.88; p = 0.003) and reduced visual analog scale(VAS) scores for low back pain (1.87 ± 0.68 vs. 2.24 ± 0.58; p = 0.002) in the OSE group at 7 days. The cross-sectional area of the multifidus muscle decreased less in OSE (104.71 ± 36.10) compared to UBE (268.85 ± 40.00; p < 0.001). Complication rates were similar, with no major adverse events such as infections or nerve injuries. The minimally invasive nature of OSE may contribute to improved patient outcomes and satisfaction. Further large-scale, long-term studies are warranted to validate these findings and assess the long-term efficacy of OSE in spinal surgery. Clinical trial number: Not applicable.

Kümmell disease has traditionally been defined as delayed post-traumatic vertebral collapse following a symptom-free interval. Contemporary understand