Objective: To investigate the clinical efficacy of spinal endoscopy in the treatment of lumbar spinal stenosis. Methods: Eighty patients with lumbar spinal stenosis treated in our hospital from January 2024 to June 2025 were selected and randomly divided into two groups using a random number table. Patients treated with traditional open laminectomy were assigned to the control group, while those treated with spinal endoscopic decompression were assigned to the observation group. Clinical indicators were compared between the two groups. Results: Compared with the control group, the observation group demonstrated a higher rate of excellent and good treatment outcomes after treatment, shorter operation time, earlier postoperative ambulation, shorter hospital stay, less intraoperative blood loss, higher Japanese Orthopaedic Association scores, and lower Visual Analog Scale and Oswestry Disability Index scores (P < 0.05). The overall complication rate was lower in the observation group than in the control group (P < 0.05). Conclusion: Spinal endoscopy for the treatment of lumbar spinal stenosis offers advantages such as minimal surgical trauma, less intraoperative bleeding, rapid postoperative recovery, and fewer complications. It effectively improves lumbar spine function, alleviates pain, and enhances clinical efficacy, making it worthy of clinical promotion and application.