Objective To explore the application effect of robot-assisted surgery combined with three-dimensional (3D) image registration for lumbar disc herniation. Methods 112 patients with lumbar disc herniation who underwent surgery in Baoji Central Hospital from January 2021 to December 2022 were selected, and were divided into the robot-assisted surgery group (robot group, n＝56) and traditional open surgery group (traditional group, n＝56). The operation time, intraoperative blood loss, postoperative hospital stay, and other indicators were compared between the two groups. Visual analogue scale (VAS) and Oswestry disability index (ODI) were used to evaluate the efficacy at 6 and 12 months after surgery. Results There were no significant differences in gender, age, body mass index (BMI), disease course and lesion segment between the robot group and the traditional group. In the robot group, the average image registration time was (7.8±2.1) min, the registration accuracy was within 1 mm, and the success rate of intraoperative navigation positioning was 98.21% (55/56). Compared with traditional group, the operation time and postoperative hospital stay were shorter and intraoperative blood loss was less in the robot group (P＜0.01). The total incidence of postoperative complications was 3.57% (2/56) and 14.29% (8/56) in the robot group and the traditional group, respectively (P＞0.05). The VAS scores and ODI values in the robot group were lower than those in the traditional group at 6 and 12 months after surgery (P＜0.01). Conclusions The application of 3D medical image registration technology in robot-assisted lumbar disc herniation surgery can significantly improve surgical precise positioning, shorten operation time, reduce blood loss, and improve postoperative function, which is worthy of clinical promotion and application.