This chapter presents a unilateral laminotomy technique for bilateral decompression (ULBD) of lumbar spinal stenosis. The procedure prioritizes preservation of paraspinal muscles and ligaments while achieving complete decompression of both sides of the spinal canal. Utilizing Caspar and tubular retractor to create surgical access minimizes tissue trauma and provides access. The authors detail surgical steps, including patient and surgeon positioning, incision, and methods for both central and lateral recess decompression, bilaterally. Advantages highlighted include promising neural decompression compared to endoscopic procedure, and reduced pain, shorter recovery time, and less blood loss compared to conventional laminectomy. It is also an available and effective technique for decompression of the contralateral foraminal stenosis and contralateral extruded disc.