Objective. To analyze criteria for the accessibility and efficiency of ventral and dorsal approaches to stabilize the lumbar spinal segment LV—SI. Materials and methods. Examinations were made in 96 patients, including 57 women and 39 men, aged 23 to 68 years, who were treated at the Neurosurgery Department, Territorial Clinical Hospital of the City of Krasnoyarsk in 2012 to 2016 and re-operated on for recurrent degenerative disease of the lumbosacral spine. Of them, 42 patients were operated on via ventral approach with total diskectomy and interbody endoprosthesis; 54 patients underwent rigid transpedicular stabilization using interbody corporodesis with a cage and decompression of neural structures via dorsal approach. Results. Removal of recurrent disc herniation via ventral retroperitoneal access with interbody prosthesis was found to be the best method associated with the smallest number of complications. If there are contraindications to disc prosthesis via ventral approach, the second most effective method is to remove the herniated disc via dorsal approach with extended interlaminectomy, facetectomy, or laminectomy supplemented with transpedicular fixation with interbody corporodesis. Conclusion. The ventral approach to the lumbar spine at the level of LV—SI is characterized by a smaller length of the wound and by the lower values of the angle of surgical action and the slope angle of surgical activity than the dorsal one, which makes the technical implementation of surgery slightly difficult. The ventral approach to patients with a recurrent degenerative process at the level of LV—SI after previous intervention via dorsal access has benefits in terms of shorter surgery, less blood loss, and fewer postoperative complications.