Purpose <p>This study evaluates An Innovative Minimally Invasive Technique using extreme-oblique lumbar interbody fusion combined with percutaneous endoscopic lumbar discectomy (XOLIF + PELD) versus posterior lumbar interbody fusion (PLIF) for lumbar adjacent segment disease(ASD) treatment.</p> Methods <p>We retrospectively analyzed 58 patients (26 treated with the combined technique, 32 with posterior fusion) with minimum 24-month follow-up. Clinical outcomes (Visual Analogue Scale(VAS), Oswestry Disability Index(ODI), Short Form-36(SF-36)), radiological parameters, and perioperative data including operative time, blood loss, hospital stay, and time to mobilization were assessed. Statistical analysis was performed using paired and independent t-tests or non-parametric equivalents with significance level set at <i>p</i> &lt; 0.05.</p> Results <p>Both groups showed significant clinical and radiological improvements. The XOLIF + PELD group demonstrated advantages in operative time (108.1 ± 21.4 vs. 192.8 ± 55.6&#xa0;min), blood loss (45.3 ± 11.2 vs. 308.8 ± 108.7mL), hospital stay (2 vs. 6 days), postoperative mobilization (1 vs. 4 days), and minor complication rates (11.5% vs. 28.1%). Fusion rates were comparable (96.1% vs. 90.6%).</p> Conclusion <p>The combined extreme-oblique lumbar interbody fusion with percutaneous endoscopic lumbar discectomy(XOLIF-PELD) approach may offer a minimally invasive alternative to posterior lumbar interbody fusion(PLIF) for selected patients with adjacent segment disease, demonstrating reduced surgical trauma, faster recovery, and fewer minor complications in this retrospective analysis.Despite study limitations inherent to retrospective analyses, these promising results warrant further investigation through prospective multicenter trials.</p>