Objective To investigate the clinical efficacy of minimally invasive treatmentSof lumbar disc herniation combined with adjacent segment imaging lumbar spinal stenosis assisted by diffusion tensor imaging. Methods Analyze the patients admitted to the First Affiliated Hospital With Nanjing Medical University with lumbar disc herniation combined with adjacent segment imaging lumbar spinal stenosis who were treated with percutaneous endoscopic lumbar discectomy after the responsible segment was identified by diffusion tensor imaging (DTI) between February 2018 and February 2020. The length of surgical incision, operation time, hospitalization time and postoperative complications were observed in all patients. Patients" pain was assessed by visual analogue scale (VAS) before surgery, 1 week, 3 months, 6 months and 1 year after surgery at follow-up. The patients" neurological function and daily living ability were assessed by the Japanese Orthopaedic Association (JOA) score and the Oswestry disability index (ODI). At the final follow-up, the surgical efficacy was evaluated by using the modified MacNab criteria. Results A total of 48 patients (29 males and 19 females) with a mean age of 57.1±14.4 years, an operative time of 94.0±23.2 minutes, an incision length of 12.0±1.6 mm, and a hospital stay of 6.5±2.6 days were included. No serious postoperative complications such as nerve injury, dural rupture, or recurrence of disc herniation occurred. The mean follow-up time was 15.6±2.5 months. The VAS, radicular pain VAS and ODI scores of low back pain at each postoperative time point were significantly lower and the mJOA score was significantly higher than that before surgery (P < 0.05). At the final follow-up, the excellent rate was 89.6% (43/48). Conclusion Percutaneous endoscopic lumbar discectomy is an effective treatment for lumbar disc herniation combined with lumbar spinal stenosis in adjacent segments, with the advantages of less surgical trauma, fewer complications, and faster recovery, etc. The short-term clinical efficacy is remarkable, but the long-term efficacy and the development of adjacent segments need further observation.