Objective To evaluate and compare the effects of endoscopic spinal surgery performed via the Kambin's triangle approach and the posterior interlaminar approach on patients diagnosed with lumbar disc herniation （LDH） and concurrent lateral recess stenosis. Methods The clinical data of patients who underwent lumbar pedicle screw fixation at our hospital between January 2017 and December 2023 were retrospectively analyzed. Patient information including sex， age， diagnosis， surgical level， presence and type of postoperative neurological complications was recorded. Based on postoperative CT scans， the zone and grade of screw penetration were assessed， and the distribution of different types of pedicle screw penetration was documented. The association between specific types of pedicle screw penetration and the occurrence of postoperative neurological symptoms was then analyzed. Results The operation time and postoperative hospital stay in the Kambin group were significantly shorter than those in the interlaminar group （P < 0.05）. On postoperative day 1 and at 1 month postoperatively， the VAS scores in the Kambin group were significantly lower than those in the interlaminar group （P < 0.05）. No significant differences were observed between the two groups in terms of ODI scores on postoperative day 1 and at 3 months postoperatively， or in the postoperative area of lateral recess stenosis （P > 0.05）. One case of postoperative infection was reported in the interlaminar group. Conclusions For patients with LDH and lateral recess stenosis， endoscopic spinal surgery via the Kambin's triangle approach is associated with a shorter operative duration. Both the Kambin's triangle approach and the interlaminar approach can effectively improve functional outcomes and decompress the lateral recess. However， the interlaminar approach requires further optimization to minimize the risk of complications.