Objective To compare the efficacy of unilateral two channel endoscopic spinal canal decompression and total endoscopic visual spinal canal decompression in the treatment of lumbar spinal stenosis. Methods The clinical data of 213 patients with lumbar spinal stenosis treated in the Second Affiliated Hospital of Anhui Medical University and Hefei Third People's Hospital from May 2018 to May 2021 were analyzed retrospectively. There were 81 cases in the control group, including 49 cases in the Second Affiliated Hospital of Anyi University and 32 cases in the Third Affiliated Hospital of Hefei. According to the operation method, they were divided into two groups, 132 cases in the observation group and 81 cases in the control group. The observation group was treated with unilateral dual channel endoscopic spinal canal decompression (UBE), and the control group was treated with total endoscopic visual spinal canal decompression (PFELFD). The clinical results were analyzed by Oswestry disability index (ODI), visual analogue scale (VAS) and modified macnab standard. The perioperative conditions of the two groups were observed, and the intervertebral disc height, lumbar intervertebral angle and Anteroposterior diameter of lateral recess and anteroposterior diameter of central spinal canal. Results The scores of ODI and vas in the two groups were significantly lower than those in the same group before operation, and there was significant difference between the two groups (P < 0.05). The scores of ODI and vas in the observation group were lower than those in the control group 12 months after operation, but there was no significant difference between the two groups (P>0.05). According to Macnab standard, 12 months after operation, the excellent and good rate of the observation group was 90.91%, while that of the control group was 81.48%, the comparison between the two groups was statistically significant (x2 = 4.031, P= 0.045); the intraoperative radiation exposure time of the observation group was less than that of the control group, and the number of cases of dural tear and nerve root injury were less than those of the control group. The difference between the two groups was statistically significant (P<0.05); the indexes of postoperative intervertebral disc height, lumbar interbody angulation, anterior posterior diameter of lateral recess and anterior posterior diameter of central spinal canal in the same group were greater than those in the same group, and the anterior posterior diameter of posterior recess and anterior posterior diameter of central spinal canal in the observation group were significantly greater than those in the control group (P<0.05). Conclusion UBE can improve the pain of patients with lumbar spinal stenosis with significant clinical effect and will not increase postoperative complications. UBE can be widely used in clinic.