[OBJECTIVE] To evaluate the efficacy of the extreme lateral transpsoas approach to the low-grade lumbar spondylolisthesis.[METHODS] A retrospective study, from 2012 to 2017, 54 patients of low-grade lumbar spondylolisthesis, underwent minimally invasive XLIF procedure using 2 different fixation(lateral fixation in 30 patients and bilateral pedicle screw fixation in 24 patients). The following data were compared between the 2 groups：surgical time，blood loss，cage subsidence, fusion rate. Radiologic parameters (slipping percentage, foraminal height, disc height, lumbar lordotic angle, and anterior-posterior diameter of the canal) were measured preoperatively and postoperatively. Clinical outcomes were evaluated using Japanese Orthopaedic Association (JOA) and visual analog scale (VAS) scores.[RESULTS] The disc height, foraminal height, rate of spondylolisthesis reduction, lumbar lordotic angle and anterior-posterior diameter of the canal were significantly increased from preoperatively to each time follow-up in lateral fixation and bilateral pedicle screw fixation groups (P﹤0.05). Although the surgical time and blood loss in the lateral fixation group were significantly less than the bilateral pedicle screw fixation group (P﹤0.05). But the mean correction of vertebral slippage measured on lateral lumbar X-ray was 42.30% in the lateral fixation group and 58.42% in the bilateral pedicle screw fixation group (P﹤0.05). At the last follow-up, cage subsidence was similar between the 2 groups(P﹥0.05).The fusion rate was 80% in lateral fixation group and 83.33% in bilateral pedicle screw fixation group. At preoperative and last follow-up postoperative, VAS and JOA scores of the 2 groups did not show significant differences (P﹥0.05). From preoperative to last follow-up postoperative, the VAS and JOA scores were significantly improved in all groups (P﹤0.05). [CONCLUSIONS] XLIF is a reliable minimally invasive technique to treat low-grade lumbar spondylolisthesis. No significant differences in radiologic and clinical outcomes were found among the lateral fixation and bilateral pedicle screw fixation in extreme lateral transpsoas approach.