Objective To compare the efficacy of percutaneous transforaminal endoscopic discectomy （PTED） versus traditional posterior laminotomy decompression in the treatment of lumbar disc herniation. Methods A total of 90 patients with lumbar disc herniation admitted to our hospital between January 2022 and January 2024 were selected and randomly divided into a control group and an observation group by random number table method. The control group （45 cases） underwent traditional posterior laminotomy decompression combined with nucleotomy, while the observation group （45 cases） received PTED combined with nucleotomy. The following parameters were compared between the two groups： surgical parameters （operation time, time of first postoperative ambulation, incision length, and intraoperative blood loss）, lumbar spine functional recovery [Oswestry Disability Index （ODI）, Japanese Orthopaedic Association （JOA） score, and Visual analog scale （VAS） score], serum markers [C-reactive protein （CRP）, interleukin-1β （IL-1β）, and matrix metalloproteinase-3 （MMP-3）], and complication rates. Results The observation group exhibited shorter operation time and first postoperative ambulation time compared to the control group, as well as lower intraoperative incision length and less blood loss （P<0.05）. No statistically significant differences in ODI, JOA, and VAS scores were observed between the groups before treatment （P>0.05）; 6 months after operation, compared to the control group, the observation group had lower ODI scores （with an improvement rate of over 90%）, higher JOA scores, and lower VAS scores （P<0.05）. No significant differences in CRP, IL-1β, and MMP-3 were noted between the groups preoperatively （P>0.05）; postoperatively, the observation group demonstrated lower levels of CRP, IL-1β, and MMP-3 than the control group （P<0.05）. The total complication rates were 22.22% and 6.67% in the control and observation groups, respectively （P<0.05）. Conclusion In the treatment of lumbar disc herniation, PTED combined with nucleotomy demonstrates superior clinical efficacy, effectively accelerating surgical and postoperative recovery process, improving lumbar function, and reducing inflammatory response and complication rates, which is worth clinical promoting.