Endoscopic spine surgery (ESS) is increasingly being utilized to address lumbar spine pathology and is growing in popularity in the United States. An expanding body of literature demonstrates rapid functional recovery with reduced morbidity compared to open techniques. Full endoscopic spine surgery (FESS), or uniportal endoscopy, involves a single channel through which an endoscope and instruments are introduced. Unilateral biportal endoscopy (UBE) utilizes two separate channels, one for viewing and another for working with surgical instruments. Endoscopic techniques for cervical, thoracic, and lumbar decompression as well as for lumbar fusion have been developed. Uniportal and biportal endoscopic approaches for lumbar decompression are described in this chapter.