The purpose of this study was to evaluate the efficacy of direct decompression (DD) against indirect decompression (ID) in treating lumbar spondylolisthesis and to compare the results at 3 and 12 months. It is still up for discussion which surgical approach is best for correcting lumbar spondylolisthesis. Although new ID-based procedures have demonstrated better radiographic outcomes than DD, questions remain about whether or not they provide sufficient decompression. There is a lack of current evidence contrasting the clinical success rates of DD and ID. Patients with DD and ID between April 2013 and January 2019 were retrieved from the Quality Outcomes Database (QOD), a national, multicenter prospective spine registry. Researchers computed propensity scores for each treatment using logistic regression with baseline covariates potentially related to outcomes. Patients who were not similar were screened out using the propensity scores. Treatment and covariate were used as independent factors in a multivariable regression analysis, with results serving as the dependent variable. The DD group comprised a total of 4,163 patients, while the ID group had a mere 86 people. Significantly decreased odds of a longer hospital stay and of obtaining a 30% improvement in back and leg pain at 3 months were seen in the ID group compared to the control group. As of 12 months, these tendencies had not reached statistical significance. At either 3 or 12 months, there were no variations in ED5D or Oswestry disability index 30% improvement scores. At 3 months, the rate of patients requiring a second operation was considerably greater among those with ID (4.9% vs. 1.5%, P=0.015). These findings demonstrate that the clinical outcomes of DD and ID for the treatment of lumbar spondylolisthesis are comparable, with the exception that patients treated with ID had a smaller reduction in back and leg pain at 3 months and a greater reoperation rate at 3 months. Surgeons can use this knowledge to better advise their patients on the benefits and risks of ID versus DD surgery.