Abstract: [Objective] To compare the clinical efficacy of endoscopic lumbar interbody fusion versus open counterpart in the treatment of grade II lumbar spondylolisthesis complicated with lumbar spinal stenosis. [Methods] A retrospective analysis was done on 128 patients who had grade II lumbar spondylolisthesis with spinal stenosis treated surgically in our hospital from June 2020 to June 2022. According to doctor-patient communication, 56 patients received endoscopic decompression and fusion, while other 72 patients underwent open decompression and fusion. The perioperative, follow-up and imaging data of the two groups were compared. [Results] All patients in both groups had the corresponding surgical procedures performed successfully. The endoscopic group proved significantly superior to the open group in terms of operation time [(151.7±16.0) min vs (179.4±13.0) min, P＜0.001], total incision length [(4.3±1.1) cm vs (7.3±0.9) cm, P＜0.001], intraoperative blood loss [(165.0±47.0) mL vs (272.2±51.3) mL, P＜0.001], postoperative ambulation [(1.6±0.4) days vs (4.9±1.2) days, P＜0.001] and hospitalization [(7.3±1.9) days vs (13.3±1.1) days, P＜0.001], whereas the former consumed significantly more intraoperative fluoroscopy times than the latter [(13.3±14.5) times vs (7.5±2.0) times, P＜0.001]. All patients in both groups were followed up for more than 12 months, and there was no significant difference in the time to regain full weight-bearing activities between the two groups (P＞0.05). As time went on, the lower back pain VAS, leg pain VAS, ODI and JOA scores in both groups were significantly improved (P＜0.05). The endoscopic group was significantly better than the open group regarding to low back pain VAS score 7 days after surgery [(3.1±0.8) vs (3.7±0.6), P＜0.001], despite of the fact that no statistically significant differences were noted in the other abovementioned items between the two groups (P＞0.05). Regarding imaging, the spinal canal area, intervertebral space height, lumbar lordotic angle and slippage rate were significantly improved in both groups at the last follow-up compared with those preoperatively (P＜0.05), whereas which were not statistically significant between the two groups at any corresponding time points (P＞0.05). [Conclusion] The endoscopic decompression and fusion have obvious advantages of less trauma, shorter hospital stay and less intraoperative bleeding over the open counterpart for grade II lumbar spondylolisthesis complicated with spinal stenosis.