Objective: To explore the clinical efficacy of perioperative nursing based on Enhanced Recovery After Surgery (ERAS) in patients receiving unilateral biportal endoscopy (UBE) for lumbar degenerative diseases (LDD), and to provide objective evidence for optimizing postoperative rehabilitation regimens. Methods: A total of 95 patients diagnosed with LDD who underwent UBE surgery from February 2024 to June 2025 were retrospectively enrolled and categorized into a conventional rehabilitation group (n = 49) and an ERAS group (n = 46) according to different postoperative rehabilitation protocols. The conventional group received routine traditional perioperative nursing, whereas the ERAS group was managed with a comprehensive perioperative regimen consisting of preoperative health education, preoperative nutritional support, preemptive analgesia, intraoperative humanistic care, and graded postoperative rehabilitation training. Baseline demographic data, health economic indicators including length of hospital stay and total hospitalization expense, as well as postoperative outcome indexes involving VAS, BI, and ODI scores, were statistically compared between the two cohorts. Results: No statistically significant intergroup differences were detected in baseline data (p＞0.05). From the perspective of health economics, the ERAS group yielded remarkably shorter hospital stay (7.89 ± 0.24 days vs 8.92 ± 0.41 days) and lower total hospitalization cost (32402 ± 592.1 CNY vs 35166 ± 1128 CNY), with statistically significant discrepancies (p = 0.036). In terms of postoperative functional recovery, the ERAS group achieved markedly lower VAS scores at postoperative day 5 and day 7 (1.70 ± 0.08, 0.44 ± 0.11 versus 2.14 ± 0.09, 0.82 ± 0.11, p＜0.05); the Barthel Index (BI) at postoperative day 2 was statistically higher in the ERAS group (65.87 ± 2.14 vs 58.57 ± 2.41, p = 0.027); meanwhile, the Oswestry Disability Index (ODI) measured at 3 months after surgery was significantly reduced in the ERAS cohort (21.43 ± 0.93 vs 25.62 ± 1.05, p = 0.004). Conclusion: The application of ERAS-based standardized perioperative nursing in UBE surgery for LDD can effectively shorten hospitalization duration, cut down medical expenditure, accelerate postoperative pain relief, improve recovery of activities of daily living, and facilitate the rehabilitation of lumbar spinal function, which delivers prominent clinical and economic benefits and deserves widespread clinical promotion.