To investigate the feasibility and effectiveness of uni-portal non-coaxial spinal endoscopic surgery (UNSES) via a single incision for the treatment of adjacent two-segmental lumbar disc herniation (LDH). A retrospective analysis was performed on 33 adjacent two-segmental LDH patients treated with single-incision UNSES between June 2023 and May 2025, including 18 males and 15 females, with a mean age of 55.7 years (range, 28-74 years) and a mean disease duration of 11.2 months (range, 3-36 months). There were 4 cases of L 3, 4, L 4, 5 herniation and 29 cases of L 4, 5 and L 5, S 1 herniation. Pfirrmann grade of disc degeneration was grade 3 in 24 segments, grade 4 in 39 segments, and grade 5 in 3 segments. Perioperative indicators were recorded. The visual analogue scale (VAS) score and Oswestry Disability Index (ODI) were evaluated preoperatively and at 3 days, 3 and 6 months postoperatively. The modified MacNab criteria were used to assess patient satisfaction at last follow-up. Postoperative lumbar CT or MRI was applied to evaluate nerve root decompression. Lumbar lordosis angle and L 3, 4, L 4, 5, and L 5, S 1 segmental endplate angles on standing lateral X-ray films were measured to compare sagittal balance changes before operation and at last follow-up. The operation time was 70-126 minutes, with an average of 84.8 minutes; the incision length was 1.8-2.4 cm, with an average of 2.1 cm; the fluoroscopy frequency was 1-4 times, with an average of 2.2 times; and the hospital stay was 5-12 days, with an average of 7.6 days. All patients were followed up 6-24 months, with an average of 14.1 months. The incidence of complications was 6.1% (2/33), including 1 case of dural tear (<4 mm) required no suture and presented no cerebrospinal fluid leakage, and 1 case complete inferior articular process resection had no obvious low back pain during follow-up. No myeloid hypertension-like syndrome, nerve root injury, cerebrospinal fluid leakage, or intervertebral space infection occurred in other patients. VAS score of low back and leg pain and ODI at each time point after operation were lower than those before operation, and further decreased with time, and the differences between different time points were significant ( P<0.05). According to the modified MacNab criteria, 19 cases were excellent, 10 cases were good, 4 cases were fair, and the excellent and good rate was 87.9%. Postoperative lumbar MRI showed that the herniated nucleus pulposus tissue had been removed in all patients, the cross-sectional area of the spinal canal was significantly increased, and the nerve root was not significantly compressed. At last follow-up, there was no significant difference in lumbar lordosis angle, L 3, 4 endplate angle, L 4, 5 endplate angle, and L 5, S 1 endplate angle when compared with those before operation ( P>0.05). Single-incision UNSES has the advantages of small trauma, high safety, flexible operation, and extensive decompression, which can effectively complete the removal of two adjacent segments herniated disc, and the effectiveness is satisfactory. 探讨单孔非同轴脊柱内镜手术（uni-portal non-coaxial spinal endoscopic surgery，UNSES）通过单切口治疗相邻两节段腰椎间盘突出症（lumbar disc herniation，LDH）的可行性及临床疗效。. 回顾分析2023年6月—2025年5月采用单切口UNSES治疗的33例相邻两节段LDH患者临床资料。其中男18例，女15例；年龄28～74岁，平均55.7岁。病程3～36个月，平均11.2个月。病变节段：L 3、4和L 4、5 4例，L 4、5和L 5、S 1 29例。椎间盘退变Pfirrmann分级：3级24节段，4级39节段，5级3节段。记录围术期相关资料；术前及术后3 d、3个月、6个月采用腰腿疼痛视觉模拟评分（VAS）及Oswestry功能障碍指数（ODI）评价患者临床症状转归；末次随访时采用改良MacNab标准评价患者术后满意度；术后复查腰椎CT或MRI评价神经根减压是否充分；术前及末次随访时于站立位X线片上测量腰椎前凸角、L 3、4终板角、L 4、5终板角及L 5、S 1终板角，评估手术前后矢状面平衡变化。. 手术均顺利完成，手术时间70～126 min，平均84.8 min；切口长度1.8～2.4 cm，平均2.1 cm；术中透视1～4次，平均2.2次；住院时间5～12 d，平均7.6 d。所有患者均获随访，随访时间6～24个月，平均14.1个月。并发症发生率6.1%（2/33），其中1例硬脊膜撕裂（撕裂口<4 mm），未缝合，术后无脑脊液漏；1例下关节突被完全磨除，随访期间未出现明显腰痛症状。其余患者无类脊髓高压综合征、神经根损伤、脑脊液漏、椎间隙感染等并发症发生。术后各时间点腰腿痛VAS评分及ODI均较术前降低，并且随时间延长进一步降低，各时间点间比较差异均有统计学意义（ P<0.05）。末次随访时采用改良MacNab标准评价，获优19例、良10例、可 4 例，优良率87.9%。术后腰椎MRI示所有患者突出髓核组织均已摘除，椎管横截面积明显增加，神经根未见明显受压。末次随访时，腰椎前凸角、L 3、4终板角、L 4、5终板角及L 5、S 1终板角与术前比较差异均无统计学意义（ P>0.05）。. 单切口UNSES具有创伤小、安全性高、操作自由、减压范围广等优势，可有效完成相邻两节段腰椎间盘摘除，临床疗效满意。.
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