Introduction Uni-portal endoscopic interlaminar lumbar decompression is increasingly adopted for lumbar disc herniation and canal stenosis. However, outcome data during the early learning curve with at least one‑year follow‑up remain limited. This study evaluates the clinical and radiological outcomes of the first 35 consecutive cases performed over a one‑year period, providing practical insights for new endoscopic surgeons.

Material and Method: Between July 2023 and June 2024, 35 patients (23 lumbar disc herniation, 12 lumbar canal stenosis) underwent uni-portal endoscopic interlaminar decompression. Demographics, operative time, complications, and clinical outcomes were prospectively recorded. Pain was assessed using the Visual Analog Scale (VAS) for leg and back pain, and functional outcomes were evaluated using the Oswestry Disability Index (ODI). Minimum follow‑up was 12 months (mean 13.6 ± 1.2 months).

Results: The mean age was 49.6 ± 11.2 years (20 males, 15 females). The mean operative time for the first 10 cases was 180 ± 22 minutes, which decreased to 108 ± 15 minutes in the subsequent 25 cases, reflecting a steep learning curve. At one‑year follow‑up, mean VAS scores for leg pain improved from 7.8 ± 0.9 preoperatively to 2.0 ± 0.8, while back pain improved from 6.2 ± 1.1 to 2.3 ± 0.9 (p < 0.001 for both). ODI scores improved from 58.4 ± 7.6% to 18.9 ± 5.4% (p < 0.001). Dysesthesia occurred in 7 patients (20%), all transient and resolving within 6–8 weeks. One patient (2.8%) with a broad‑based herniation required revision due to incomplete decompression. No neurological deterioration, dural tears, infections, or hematomas were observed. The mean hospital stay was 1.3 ± 0.6 days and return to routine activities occurred at 3.8 ± 1.2 weeks. Clinical improvements were maintained at one‑year follow‑up.

Conclusion: Uni-portal endoscopic interlaminar lumbar decompression provides significant and durable pain relief with functional improvement at one year, even during the initial learning curve. Operative efficiency improves rapidly, supporting the safety, efficacy, and reproducibility of this minimally invasive technique for both lumbar disc herniation and canal stenosis.