Objective To evaluate the clinical efficacy and value of percutaneous transforaminal endoscopic discectomy (PTED) in the treatment of lumbar disc herniation in middle-aged and elderly patients. Methods A prospective study was performed to analyze 50 patients (50 to 72 years old) with lumbar disc herniation undergoing PTED resection of the nucleus pulposus of the intervertebral disc in our department from March 2016 to September 2018. Another 50 patients aged 50-71 years who underwent fenestration or semi-laminar resection and decompression of the disc nucleus pulposus during the same period were recruited and served as control group. The intraoperative blood loss volume, operation time, postoperative length of hospital stay, pain visual analogue scale (VAS) scores at 1 day, 1 and 3 months postoperatively, and Oswestry dysfunction index (ODI) at 3 months postoperatively, and results of modified MacNab criteria at 6 months postoperatively were used to assess the efficacy of surgery. MRI was performed in 3-6 months after operation to observe the changes of the spinal canal and intervertebral disc protrusion before and after operation.STATA statistics 12.0 was used to perform the statistical analysis. Results No significant difference was seen in age and VAS and ODI scores before operation between the two groups (P>0.05), but the postoperative VAS and ODI scores were significantly decreased than those before surgery (P<0.01). The VAS scores in 1 day and 1 month were significantly lower in the PTED group than the control group (P<0.01), but no such difference was observed in the scores at 3 months postoperatively (P>0.05). The results of modified MacNab criteria at 6 months after surgery indicated that there was no significant difference in the function between the two groups (P>0.05). The PTED group had less intraoperative blood loss and shorter postoperative length of hospital stay than the control group (P<0.01), and no difference in operation time (P>0.05). As shown by MRI,compared with preoperative conditions, the herniation of intervertebral disc disappeared or decreased obviously, and the spinal canal was unobstructed and the area was increased obviously in 3-6 months after operation. Conclusion PTED technique can obtain similar mid-term outcomes as open surgery in the treatment of intervertebral disc herniation in middle-aged and elderly patients. PTED has good short-term effect, less damage, quick recovery and less complications.