Abstract: objective to verify the clinical efficacy of UBE in the treatment of lumbar spinal stenosis by using unilateral biportal endoscopy (UBE) and TLIF . Methods 60 patients with lumbar spinal stenosis diagnosed in our department from April 2020 to March 2022 were randomly divided into two groups, with 30 patients in each group. One group was treated with UBE surgery , The orther was treated with TLIF surgery . VAS score and ODI score of low back and leg pain and Macnab function evaluation in the last follow-up were observed before and after operation. The hospitalization time, preoperative and postoperative hemoglobin difference, and various postoperative complications. Results 60 cases were followed up for at least 3 months. There was no significant difference in VAS score of leg pain before and after operation between the two groups. The VAS score of low back pain in the UBE group was lower than that in the TLIF group at 1 week, 1 month and 3 months after operation, and the difference was statistically significant (P﹤0.05); The ODI score of the UBE group was lower than that of the TLIF group at 1 and 3 months after operation, and the difference was statistically significant (P﹤0.05). There was no significant difference between the two groups before operation, 6 and 12 months after operation.At the last follow-up, the excellent and good rate of Macnab function was 93.7% in the UBE group and 86.7% in the TLIF group, and the difference was not statistically significant. The average postoperative hospitalization time in the UBE group was (6.17 ± 2.44) days and that in the TLIF group was (10.73 ± 4.00) days. The difference in hemoglobin between the UBE group (11.33 ± 7.82) g/l and the TLIF group (25.00 ± 8.28) g/l was statistically significant (P < 0.05).There was 1 cauda equina nerve injury in the UBE group, 1 reoperation, 2 nerve root laceration with cerebrospinal fluid leakage in the TLIF group, and 2 poor wound healing. There was no intraspinal hematoma and infection in both groups. Conclusion UBE technique can be used to treat lumbar spinal stenosis with individualized surgical methods. Unilateral approach and bilateral decompression can reduce the damage to spinal stability and paravertebral muscle, reduce the rate of intervertebral fusion, and have small trauma, light postoperative low back pain, satisfactory curative effect, gentle learning curve, easy to master, which is worthy of promotion.