Objective: To compare the effects of channel assisted minimally invasive transforaminal lumbar interbody fusion (MIS-TLIF) with bilateral decompression through unilateral approach and bilateral decompression through bilateral approach in the treatment of lumbar spinal stenosis. Methods: 102 patients with lumbar spinal stenosis in our hospita were enrolled, and a random number table was used to divide into two groups, with 51 cases in each group. Group A was treated with channel assisted bilateral decompression via MIS-TLIF unilateral approach, while group B was treated with channel assisted bilateral decompression via MIS-TLIF bilateral approach. The operation indexes, lumbar and leg pain, lumbar dysfunction index (ODI) scores and intervertebral space height indexES before operation, 1 month after operation, 3 months after operation, 6 months after operation, decompression effect and complication rates were compared between the two groups. Results: The operation time and postoperative ambulation time in group A were shorter than those in group B (P < 0.05), and the number of intraoperative fluoroscopy and intraoperative bleeding were less than those in group B (P < 0.05). There was no significant difference between the two groups in postoperative hospital stay, leg pain scores at different moments and intervertebral space height indexes (P > 0.05), and the scores of low back pain and ODI at 1 month, 3 months and 6 months after operation were lower than those in group B (P < 0.05). The proportion of inadequate decompression in group A was higher than that in group B (P < 0.05). There was no significant difference in the incidence of complications between the two groups (P > 0.05). Conclusion: Channel assisted bilateral decompression via MIS-TLIF unilateral approach and bilateral decompression via bilateral approach in the treatment of lumbar spinal stenosis can fully decompress the nerve, but the former gets out of bed early and recovers quickly after operation, which is in line with the concept of enhanced recovery after surgery, and the long-term lumbar pain and lumbar function are better than the latter.