Objective To compare the clinical efficacy of large channel single-port spinal endoscope and open bilateral laminectomy in the treatment of degenerative lumbar spinal stenosis, and explore and evaluate the advantages and disadvantages of this technology. Methods From September 2020 to October 2021, 80 patients with DLSS with bilateral symptoms were randomly divided into observation group A (40 cases) and control group B (40 cases). Patients in group A were treated with delta spinal endoscopy, and patients in group B were treated with open bilateral laminectomy. The wound evaluation indexes such as incision length, operation time, intraoperative bleeding, hospital stay and postoperative complications were recorded. Combined with regular follow-up, visual analogue scale (VAS) and Oswestry disability index (ODI) of low back and leg pain were recorded before operation, 1 week, 3 months, 6 months and 12 months after operation. At the same time, the clinical efficacy of the two groups was evaluated by modified macnab standard 12 months after operation. Results All 80 patients completed the surgery successfully, and there were no losses to follow-up. The incision length (1.00±0.12) cm, intraoperative blood loss (65.18±8.25) ml, and hospitalization time (5.19±1.54) d were lower in group A than in group B (3.75±0.57) cm, (145.72±14.51) ml, and (7.55±0.83) d, with statistically significant differences (P<0.05). However, the operation time in group B (67.56±12.51) min was lower than that in group A (90.41±11.93) min, and the differences were statistically significant (P<0.05). The VAS and ODI in both groups improved significantly after surgery compared with the preoperation. The VAS and ODI in group A patients after surgery were lower than those in group B, and only 1 week after surgery, the differences in VAS for back pain and ODI between the two groups had statistical significance (P<0.05). The excellent rate of modified MacNab criteria at 12 months after surgery was 92.5% (37/40) in group A and 87.5% (35/40) in group B, but the difference was not statistically significant (P>0.05). The incidence of postoperative complications in group A was 5% (2/40), which was lower than that in group B （12.5% （5/40）, but the difference was not statistically significant (P>0.05). Conclusion Delta spinal endoscopy can effectively deal with DLSS through the lumbar posterior interlaminar approach. It can not only achieve the curative effect of open surgery, but also reduce pressure more accurately, and minimally invasive compared with classical open surgery, and patients recover faster. It is a safe, effective and minimally invasive surgical method, which is expected to become the first choice