Abstract Objective To prospectively study the clinical efficacy of bilateral paraspinal approach lumbar interbody fusion (BPA-TLIF) and Unilateral Biportal Endoscopic lumbar interbody fusion (ULIF) in the treatment of lumbar disc herniation in middle-aged and elderly patients.Methods From January 2019 to December 2021, 67 patients with lumbar disc herniation who met the inclusion criteria were selected. According to the method of random number table, the patients were divided into BPA-TLIF group and ULIF group. There were 34 patients in BPA-TLIF group, including 16 males and 18 females, with an average age of 62.59 ± 4.37 years; 4 cases of L3/4, 19 cases of L4/5, and 11 cases of L5/S1. 33 patients in the ULIF group, including 15 males and 18 females, with an average age of 63.12 ± 5.22 years; 3 cases of L3/4, 17 cases of L4/5, 13 cases of L5/S1. The perioperative data of the two groups were recorded, including the visual analogue scale(VAS) and Oswestry dysfunction index(ODI) before and 1 and 3 months after the operation.Results (1) The two groups of patients were operated successfully. In the ULIF group, 6 patients had dural injury and 3 patients had cerebrospinal fluid leakage, they were cured after raising the bed and reducing the pressure, with a statistically significant difference (P<0.05). The incision length, intraoperative bleeding and hospital stay in BPA-TLIF group were significantly longer than those in ULIF group (P<0.001). The operation time of BPA-TLIF group was significantly shorter than that of ULIF group (P<0.001).(2)The follow-up period was 12-16 months, with an average of 14.18 ± 1.03 months. 1 month after operation, the VAS score of ULIF group was significantly lower than that of BPA-TLIF group (P<0.05), but 3 months after operation, there was no significant difference between the two groups (P>0.05). At 1 and 3 months after operation, the ODI score of ULIF group was lower than that of BPA-TLIF group (P<0.05). At the last follow-up, there was no significant difference in VAS and ODI between the two groups (P>0.05). (3) The mean time of firm fusion was 15.37 ± 3.04 weeks. The area of dural sac and the height of intervertebral space in the two groups after operation were significantly higher than those before operation (P<0.001), and there was no significant difference between the two groups (P>0.05).Conclusion The treatment of lumbar disc herniation in the elderly with ULIF could shorten the hospitalization time, reduce the amount of bleeding, relieve the postoperative pain of lumbar dorsal muscles, and promote the recovery of patients.