60 patients with lumbar spinal stenosis were randomized to receive either full-endoscopic decompression (FE; n=30) or tubular-based microscopic decompression (TM; n=30). The primary outcome of interest was Oswestry Disability Index (ODI) scores at 24 months. Secondary outcomes included ODI scores at all other time points, leg, and back pain on a Visual Analog Scale (VAS), Euro-QoL 5-Dimensions (EQ-5D), walking time, estimated blood loss, length of stay, satisfaction, and the incidence of adverse events. Both groups showed significant improvements from baseline with regard to ODI scores after 24 months. There were significant improvements in all secondary outcomes (back and leg pain, EQ-5D, and walking time). Mean VAS back pain scores showed significant improvements in the FE group compared to the TM group after postoperative day 1, and 6, 12, & 24 months postoperation. Operative and radiation time were similar between the two groups but mean estimated blood loss was significantly lower in the FE group. The results showed that FE is non-inferior to TM for the treatment of lumbar spinal stenosis.