Background Minimally invasive decompressive procedures have evolved into the modern standard surgical solution for degenerative lumbar spinal stenosis (DLSS) patients, such as the bilateral laminotomy and the unilateral laminotomy for bilateral decompression (ULBD) that is characterized by ipsilateral and contralateral microdecompression under the midline posterior structures and has been successfully used with proven efficacy. Objective To compare the effect of the size of the skin incision and the method of handling the multifidus muscle on the clinical outcomes of the endoscopic laminotomy versus the standard microscopic laminotomy for DLSS. Patients and methods Primary outcome data included the numerical rating scale for back and leg symptoms and Oswestry Disability Index to quantify pain and disability, respectively. Secondary outcome data included operative time, blood loss, and modified Mcnab criteria. Results At the end of the follow-up period, the rate of successful outcome of the endoscopic group was 87.2 and 77.8% for the control group after initial improvement by 87% at 3-month follow-up. The incidence of complications was 13% in both groups. Conclusion For DLSS, the endoscopic ULBD in experienced hands would have a better outcome than the microscopic ULBD regarding the postoperative clinical outcome and patient satisfaction.