Objective To evaluate the clinical efficacy of unilateral approach with bilateral decompression via spinal minimally invasive channel in the treatment of lumbar spinal stenosis. Methods A retrospective study was conducted on 50 patients with lumbar spinal stenosis who received surgical treatment at Second People's Hospital of Qinzhou from July 2019 to June 2023. All patients underwent unilateral approach with bilateral nerve root decompression via spinal minimally invasive channel performed by the same surgical team. The operation time, intraoperative blood loss, hospital stay and other indicators were recorded. Before and on the 3rd day after surgery, the Japanese Orthopaedic Association (JOA) scores were used to evaluate lumbar function, and the Visual Analogue Scale (VAS) scores were used to assess pain. The changes in cross-sectional areas of the spinal canal and dural sac at 1, 3, and 6 months post-surgery, along with the adverse reactions during the patients' follow-up period, were recorded. Results For the 50 patients, the operation time was 75-315 (206.02±57.06) min, intraoperative blood loss was 10-25 (16.88±3.87) mL, and postoperative hospital stay was 3 (2.00, 3.80) d. Compared with preoperative values, the JOA scores of patients significantly increased and the VAS scores significantly decreased on the 3rd day after surgery, with both differences being statistically significant (all P<0.05). According to the improvement rate formula, the overall improvement rate was (50.10±8.73)%, with 6 cases (12.00%) showing significant effectiveness and 44 cases (88.00%) showing partial effectiveness. At 1 month, 3 months, and 6 months postoperatively, there were no statistically significant differences in the differences of spinal canal cross-sectional area and dural sac cross-sectional area among the 50 patients (all P>0.05). Over a 6-month postoperative follow-up period for all 50 patients, complications comprised 1 case (2.00%) of wound infection, 1 case (2.00%) of thrombosis, and 3 cases (6.00%) of nerve root irritation symptoms. Conclusion The unilateral approach with bilateral decompression via spinal minimally invasive channel represents a simple, safe, and effective minimally invasive technique for treating lumbar spinal stenosis. It can significantly alleviate clinical symptoms, reduce pain severity, and maintain stable surgical outcomes, making it a worthy procedure for clinical promotion and application.

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