Abstract:[Objective] To compare the clinical outcomes of endoscopic versus open bone grafting and pedicle screw fixation for lumbaristhmic spondylolysis in the youth. [Methods] A retrospective study was conducted on 22 patients who received surgical treatment for lum-bar isthmic spondylolysis in our department from June 2017 to January 2021. According to the preoperative doctor-patient communication,12 patients underwent the endoscopic surgery, while other 10 patients underwent the open surgery. The clinical and imaging consequencesof the two groups were compared. [Results] The endoscopic group proved significantly superior to the open group in terms of intraoperativeblood loss [(115.8±13.1) ml vs (195.0±27.2) ml, P＜0.05], postoperative ambulation time [(1.3±0.5) days vs (2.3±0.5) days, P＜0.05] and hospi-tal stay [(10.1±1.2) days vs (14.1±1.8) days, P＜0.05], but the former consumed significantly longer operation time than the latter [(115.1±11.2) min vs (100.6±7.3) min, P＜0.05]. With time of the follow-up period lasted for (14.8±2.2) months on a mean, the VAS score and ODI sig-nificantly decreased in both groups (P＜0.05), which was not statistically significant between the two groups before surgery (P＞0.05), whilethose in the endoscopic group were significantly better than the open group 1 and 3 months after surgery (P＜0.05), and then became not sta-tistically significant again between the two groups at the latest follow-up (P＞0.05). Radiographically, the isthmic healing rate increased sig-nificantly over time in both groups (P＜0.05), with no significant differences in isthmic healing quality and isthmic healing time between thetwo groups at any time points accordingly (P＞0.05). By the time of last follow-up, all patients achieved isthmic bone healing. [Conclusion]The posterior endoscopic isthmic bone grafting and pedicle screw fixation is considerably better than the traditional open counterpart for lum-bar isthmic spondylolysis.