One hundred and eighty-four patients with degenerative lumbar spinal stenosis (DLSS) were randomized to receive fenestration decompression (n=94) or percutaneous transforaminal endoscopic discectomy (PTED; n=94). Outcomes of interest included incision size, blood loss, operative time, length of hospital stay, incidence of complications peri-operatively. Furthermore pain on a Visual Analogue Scale (VAS), the Japanese Orthopedic Association (JOA) Score, and the Oswestry Disability Index (ODI) were assessed at 3, 6, and 12 months follow-up. Patient satisfaction with the surgery was measured used the modified MacNab criteria at 12 months post-operation, and complications were also assessed at final follow-up. The results of this study demonstrate a statistically significant reduction in the PTED group for length of incision, blood loss, and length of hospital stay (p<0.001) compared to the fenestration group, however no statistically significant differences were observed in surgical time (p=0.085) or incidence of complications (p=1.00). Furthermore, VAS, ODI, and JOA scores were all statistically significant in favour of the PTED group at 3 months (p<0.01) and 6 months (p<0.01) follow-up, but not at 12 months. No statistically significant difference in surgical outcomes as measured by the modified MacNab criteria at 12-months post-surgery were observed between the two groups (p>0.05). No cases of mortality, infection, thrombophlebitis, cauda equina syndrome, or respiratory injury were observed in both groups.