Objective To compare and evaluate posterior lumbar interbody fusion and posterolateral fusion in the treatment of degenerative spondylolithesis with adjacent levels of stenosis. Methods From January 2017 to December 2018, 41 patients who suffered from degenerative spondylolithesis with adjacent levels of stenosis were divided into 2 groups (A and B). The patient in group A (n=23) were performed multilevel decompression, multilevel poster lumbar interbody fusion and transpedicle instrumentation. The patient in group B (n=18) were performed multilevel decompression, poster lumbar interbody fusion of degenerative spondylolithesis, posterolateral fusion of adjacent stenotic segments and transpedicle instrumentation. Levels of lumbar degenerative spondylolithesis in two groups was L4-5 or L5-S1. All cases were classified as degree 1 to degree 2. All patients in the two groups received MRI and CT. Results All patients were followed up from 12 to 36 months. In group A, pain relief was 95.7 % (22/23). In group B, pain relief was 88.9 % (16/18). There was no infection or neurologic complication occurred in two groups. Two groups had no significant difference in follow-up clinical outcome. But operative time and intraoperative blood loss increased in group A. Conclusion Decompression and poster lumbar interbody fusion of degenerative spondylolithesis segment, posterolateral fusion of adjacent stenotic segments and decompression and multilevel poster lumbar interbody fusion provide similar outcomes in patients with degenerative spondylolithesis with adjacent levels of stenosis, However, the decompression surgery in the narrow segment of the adjacent segment is short, and the amount of bleeding is small