Abstract: [Objective] To analyze the safety and efficacy of XLIF and OLIF in the treatment of adjacent segment degeneration after lumbar fusion. [Methods] The patients with adjacent segment degeneration after lumbar interbody fusion in our hospital were retrospectively analyzed. Group x received extreme lateral lumbar interbody fusion (XLIF) (56 cases), and group O received transperitoneal lateral anterior lumbar interbody fusion (OLIF) (50 cases). The observation indexes included perioperative indexes, follow-up indexes and imaging indexes. [Results] The operation time, intraoperative blood loss and hospitalization time of group O were significantly lower than those of group x (P < 0.05); the incidence of complications of group X was significantly higher than that of group O (P < 0.05). The VAS score, ODI score and imaging indexes of low back pain in the two groups were significantly improved (P < 0.05), and the difference between the two groups was significant (P < 0.05), and group O was significantly better than group X. [Conclusion] OLIF is safe and effective in the treatment of adjacent segment degeneration after lumbar interbody fusion and can achieve good clinical and imaging correction effect.