Abstract:[Objective] To evaluate the clinical outcomes of endoscopic removal of nucleus pulposus and suture repair of annulus fibro- sus defect in the treatment of lumbar disc herniation (LDH). [Methods] From January 2019 to January 2021, a total of 82 patients who re- ceived endoscopic discectomy for LDH were included in this study. According to preoperative doctor-patient communication, 35 patients un- derwent endoscopic removal of nucleus pulposus and suture repair of annulus fibrosus defect, while other 47 patients underwent endoscopic removal of nucleus pulposus without repairing annulus fibrosus. The perioperative, follow-up and imaging data of the two groups were com- pared. [Results] All patients in both groups were operated on successfully with no serious complications, such as dural sac tear, nerve root in- jury and infection. The repaired group consumed significantly longer operation time than the non-repaired group [(66.8±11.2) min vs (58.4± 12.9) min, P=0.034], but there were no statistically significant differences between the two groups in incision length, intraoperative blood loss, postoperative time of ambulation, incision healing grade and postoperative hospital stay (P>0.05). During follow-up lasted for more than 18 months, herniation recurrence was noted in 1 case (2.8%) in the repaired group, while 2 cases (4.2%) in the non-repaired group, which was not statistically significant between the two groups (P>0.05). The VAS scores for both lower back pain and leg pain, as well as ODI scores were significantly decreased in both groups over time (P<0.05), whereas which were not statistically significant between the two groups at any time points accordingly (P>0.05). Radiographically, the cross area of the responsible spinal canal and the lumbar lordotic angle significantly increased in both groups at 10 days after surgery and the last follow-up compared with those preoperatively (P<0.05). The inter- vertebral space height of the responsible segment remained unchanged in the repaired group (P>0.05), whereas significantly declined in the non-repaired group at the latest follow-up compared with that before operation (P<0.05). At any corresponding time points, there were no sig- nificant differences in responsible spinal canal area and lumbar lordotic angle between the two groups (P>0.05). However, the repaired group had significantly higher intervertebral space height of the affected segment than the non- repaired group at the latest follow-up [(9.0±0.2) mm vs (7.4±0.5) mm, P=0.023]. [Conclusion] Endoscopic nucleus pulposus removal combined with annulus fiber repair is feasible for the treatment of lumbar disc herniation. Although the repaired group achieves similar early clinical consequences with the unrepaired group, the suture repair of annulus fibrosus defect secondary to discectomy is benefit to maintain the intervertebral space height.