Abstract:[Objective] To compare the clinical outcomes of endoscopic unilateral laminotomy and bilateral decompression (Endo-ULBD) with Endo-Surgi Plus endoscope versus open bilateral decompression for lumbar spinal stenosis in the elderly. [Methods] A retro-spective study was done on 51 patients who received surgical treatment for lumbar spinal stenosis in our hospital from December 2018 to De-cember 2020. According to the doctor-patient communication, 31 patients underwent the endoscopic decompression, while other 20 patientshad the conventional open decompression. The clinical and imaging data were compared between the two groups. [Results] All patients inboth groups had operation performed successfully. The endoscopic group was significantly superior to the open group in terms of operationtime [(73.2±21.0) min vs (178.4±22.9) min, P＜0.001], intraoperative blood loss [(7.1±3.6) ml vs (220.0±140.9) ml, P＜0.001], postoperativebed rest time [(1.5±0.4) days vs (6.4±1.8) days, P＜0.001], and hospital stay [(3.0±1.2) days vs (9.4±3.1) days, P＜0.001]. As time went by, theVAS scores of low back pain and leg pain, as well as ODI score in the two groups were significantly improved (P＜0.05), which were not statis-tically significant between the two groups at any corresponding time points (P＞0.05). At the last follow-up, there was no significant differ-ence in MacNab excellent and good rate between the two groups (P＞0.05). At the last follow-up, there was no significant change in vertebralspace height (P＞0.05), while the dural sac cross-sectional area was significantly increased in both groups compared with those before opera-tion (P＜0.05). At corresponding time points, there were no significant differences in the above image indicators between the two groups (P＞0.05). [Conclusion] The Endo-ULBD achieve good short-term clinical consequence comparable to the open surgery, while has the advan-tages of minimally invasive surgery and rapid recovery for lumbar spinal stenosis in the elderly.