PURPOSE: This retrospective cohort study aimed to compare the clinical outcomes of percutaneous transforaminal endoscopic decompression (PTED) with those of posterior lumbar interbody fusion (PLIF) for the treatment of degenerative lumbar scoliosis (DLS) with lumbar spinal stenosis (LSS). METHODS: In this study, 143 DLS patients who met the inclusion criteria from January 2016 to March 2019 were retrospectively analyzed and divided into the PTED and PLIF groups. The propensity score matching (PSM) method was used to adjust for imbalanced confounding variables between the groups. The visual analog scale (VAS) and Oswestry Disability Index (ODI) scores were then used to compare the clinical outcomes between the two groups. Furthermore, changes in radiological characteristics and surgical complications were assessed. RESULTS: After PSM, 86 patients were included in the study with a followup duration of at least five years. Postoperative VAS and ODI scores were significantly improved in both groups at all time points compared with preoperative values (p <
0.001). However, the PTED group had higher VAS scores for back pain and ODI scores than the PLIF group at five years postoperatively (p <
0.05). For radiological parameters, the Cobb angle decreased in the PLIF group but increased in the PTED group at the final followup (p <
0.05). A decrease in the adjacent disc height was observed in the PLIF group at the final followup (p <
0.001). CONCLUSION: Both PTED and PLIF achieved relatively satisfactory outcomes in treating DLS with LSS after a minimum five year followup. However, further studies are required to better determine the characteristics of spinal deformities amenable to each procedure.