Abstract: Objective: To explore the trajectories of kinesiophobia and predictive factors in patients after endoscopic lumbar interbody fusion. Methods: Using convenience sampling method, 278 patients who underwent endoscopic lumbar interbody fusion in the First Affiliated Hospital of Guangxi University of Chinese Medicine from April 2024 to September 2025 were enrolled as participants. A general information questionnaire, the Tampa scale for kinesiophobia(TSK), visual analogue scale(VAS), Oswestry disability index(ODI), eHealth literacy scale(eHEALS), chronic pain self-efficacy scale(CPSS), and Groningen orthopaedic social support scale(GOSSS) were used for baseline investigation. The TSK was used to assess patients' kinesiophobia levels at the time of postoperative ambulation, and at 2 weeks, 1 month, and 3 months after surgery. Latent growth mixture model(LGMM) was used to analyze the latent trajectory classes of postoperative kinesiophobia in patients. Multinomial logistic regression analysis was used to explore the influencing factors related to latent classes. Results: Among the 263 patients who completed the study, the total TSK scores at the time of postoperative ambulation, and at 2 weeks, 1 month and 3 months postoperatively were(41.85±6.48) points,(38.17±6.93) points,(36.13±6.27) points, and(33.89±5.95) points, respectively, showing a gradual decreasing trend(P<0.001). LGMM evaluation indicated that the 3-class model of postoperative kinesiophobia trajectories provided the best fit, and the patients were categorized into 3 classes: the persistent high kinesiophobia group(group C1, n=86, accounting for 32.70%), the moderate-decreasing kinesiophobia group(group C2, n=74, accounting for 28.14%), and the low-decreasing kinesiophobia group(group C3, n=103, accounting for 39.16%). Multinomial logistic regression analysis revealed that, with Group C3 as the reference, monthly household income per capita, VAS score, eHEALS score and CPSS score were influencing factors for patients being classified into group C2. Monthly household income per capita, Charlson comorbidity index, VAS score, ODI score, eHEALS score, CPSS score and GO-SSS score were influencing factors for patients being classified into group C1(P<0.05). Conclusion: The trajectories of kinesiophobia in patients after endoscopic lumbar interbody fusion can be classified into persistent high kinesiophobia, moderate-decreasing kinesiophobia and low-decreasing kinesiophobia. These trajectories are influenced by multiple factors; therefore, targeted clinical interventions should be delivered based on the characteristics of different trajectory classes.