Background Data: Lumbar spinal stenosis is common in elderly and obese patients. Surgical intervention should be considered only after all conservative treatment options have been proven unsuccessful. Wide laminectomy was the gold standard of treatment, but surgical failures have been reported. Recently, a less invasive decompressive surgical procedures have emerged as an alternative technique. Purpose: To compare between the unilateral laminotomy approach and conventional laminectomy approach for the treatment of lumbar canal stenosis, regarding clinical outcomes. Study Design: This is a prospective clinical randomized controlled study. Patients and Methods: This study included 30 patients with lumbar canal stenosis. 15 patients underwent unilateral laminotomy approach (Group A), while the other 15 patients underwent conventional laminectomy approach (Group B). Surgical operative time, blood loss, and hospital stay were recorded. Clinical outcomes have been assessed by Visual Analogue Scale (VAS) of leg pain and Oswestry Disability Index (ODI). Patients were followed up for 1 year postoperatively. Results: Male to female ratio was 12:18 patients. The mean age was 52.5±6.62 years in Group A and 52.2±7.24 years in Group B. The mean operative time was 73.5±14.54 minutes in Group A and 85.5±17.07 minutes in Group B. Less blood loss was recorded in Group A (127±37.43 ml) than Group B (152±50.95 ml). Three patients suffered unintended durotomy in both groups and no postoperative CSF leak occurred. Marked reduction of VAS and ODI was achieved in both groups at one-year follow-up without statistically significant difference. Conclusion: Unilateral laminotomy approach used for bilateral neural compression is an effective technique for treatment of lumbar canal stenosis in comparison to conventional laminectomy approach. (2019ESJ184)