Objective To investigate the selection of percutaneous spinal endoscopy for lumbar disc herniation with contralateral symptoms

and to perform a literature review. Methods Three patients with lumbar disc herniation with contralateral symptoms underwent percutaneous endoscopic decompression via the unilateral approach

the bilateral approach

and the ipsilateral approach as well as contralateral exploration

and related articles in China and globally were searched and analyzed. Results Two patients achieved disappearance of symptoms after surgery. One patient experienced pain and numbness in the lower extremities of the herniated side after surgery

which were gradually relieved after nerve root dehydration

anti-inflammatory treatment

and analgesic treatment

and the symptoms of the lower extremities disappeared after 1-year follow-up

while the patient still had lumbar fatigue and pain occasionally. Conclusion As for percutaneous spinal endoscopy in the treatment of lumbar disc herniation with contralateral symptoms

the surgical approach selected based on different signs and imaging findings can achieve full decompression and a satisfactory outcome. Literature review helps to understand the formation mechanism and treatment strategy for this rare disease.