Objective To investigate the efficacy of targeted one-channel percutaneous transforaminal endoscopic discectomy (TO-PTED) in the treatment of adjacent segment lumbar disc herniation (LDH) after spinal fusion surgery. Methods From January 2018 to March 2021, 45 patients with adjacent segment LDH after lumbar interbody fusion who underwent TO-PTED surgery in Baoding First Hospital of Traditional Chinese Medicine were selected as the observation group, and 45 patients with adjacent segment LDH after lumbar interbody fusion who underwent fenestration surgery of intervertebral disc nucleus pulposus in our hospital at the same time were randomly selected as the control group. The perioperative clinical data, preoperative and postoperative visual analog score (VAS), Japanese Orthopaedic Association (JOA) score and the modified Macnab standard were compared between the two groups. Results All operations were successfully completed. The operation time, intraoperative blood loss and hospital stay in the observation group were significantly lower than those in the control group, and the intraoperative X-ray fluoroscopy times and clinical excellent and good rate were significantly higher than those in the control group (P<0.05). For the intra-group comparison, the VAS score of the two groups at 1 month and 12 months after operation were significantly lower than the preoperative level, and the JOA score was significantly higher than the preoperative level (P<0.05). For the inter-group comparison, the VAS score of the observation group at 1 month and 12 months after operation were significantly lower than that of the control group at the same period, and the JOA score were significantly higher than that of the control group at the same period (P<0.05). The relative intervertebral height and segment angle in the observation group were significantly better than those in the control group one month after operation, and the relative intervertebral height and segment angle in the observation group were maintained better than those in the control group 12 months after operation (P<0.05). There was no significant difference in the relative intervertebral foramen area between the two groups before operation, 1 month and 12 months after operation, and the difference between the two groups was not statistically significant(P>0.05). Conclusion TO-PTED could significantly alleviate the pain of patients with adjacent segment LDH after spinal fusion surgery, and promote the recovery of lumbar function, which has the advantages of less trauma, less intraoperative bleeding, and rapid postoperative recovery. Its curative effect is better than that of traditional fenestration surgery of intervertebral disc nucleus pulposus and worthy of clinical application