To explore application value of percutaneous endoscopic visualization of screw placement in percutaneous endoscopic posterior lumbar interbody fusion (Endo-PLIF) pedicle screw placement.Methods A total of 50 patients with lumbar discogenic low back pain, lumbar spinal stenosis with lumbar instability, lumbar disc herniation with lumbar instability, and Lumbar spondylolisthesis (Meyerding classification I and II) with indications for lumbar fusion surgery from October 2020 to April 2021 are selected. Fifty patients were randomly divided into the two groups, A and B, with 25 patients in each group. In group A, the procedure is Endo-PLIF+Visual pedicle screw placement under percutaneous spinal endoscopy, while in group B, the procedure is Endo-PLIF+traditional percutaneous pedicle screw placement. The total number of X-ray fluoroscopies, guide wire placement time, operation time, and postoperative hospital stay are compared between the two groups. The Gertzbein-Robbins criteria are used to evaluate the excellent rate of nail placement. The preoperative and 24-hour postoperative VAS score and ODI index, modified MacNab criteria and postoperative complication rate to evaluate the efficacy. Besides, improved percutaneous endoscopic nail placement device is manufactured by 3D printing and research validates its feasibility and practicality. The above mentioned indexes were used to observe X-ray radiation for doctors and patients, minimally invasive nature, excellent rate of nail placement and surgical results. Results All patients complete the operation and follow-up visits. The total frequencies of fluoroscopy in A group is less than B group's (P＜0.05). The pedicle wire insertion time and operation time in group A are less than those in group B (P＜0.05). No significant differences are found in postoperative hospital stay in A group compared with B group (P＞0.05). There is no significant difference in VAS and ODI between the two groups compared with each other before and 24 hours after surgery (P＞0.05). However, VAS and ODI in both groups at 24-hour postoperatively are markedly ameliorated compared with those before surgery (P＜0.05). At the final follow-up, there is no significant difference in the excellent rate of modified MacNab between the two groups (P＞0.05). Comparing the two groups, the excellent rate of percutaneous endoscopic nail placement in A group is better than B group (P＜0.05). The difference in the incidence of postoperative complications is not statistically significant (P＞0.05).Conclusion Percutaneous endoscopic screw placement can reduce the number of X-ray and radiation exposure risk for doctors and patients, and the excellent rate of nail placement is relatively high. Meanwhile, the 3D-printed percutaneous endoscopic screw placement instruments have feasibility and practicality