The purpose of the study was a comparative analysis of the clinical and radiographic efficacy of minimally invasive rigid stabilization techniques and the traditional open interbody fusion with transpedicular fixation in the treatment of degenerative spondylolisthesis in elderly patients. The study included 65 elderly patients (over 60 years old) divided into 2 groups: the 1st group (MIS-TLIF, n=31), who underwent minimally invasive transforaminal interbody fusion, unilateral open contralateral transcutaneous transpedicular stabilization; the 2nd group (O-TLIF, n=34), operated using rigid stabilization from the median approach. For the comparative analysis, gender characteristics (gender, age), constitutional features (height, weight, body mass index), ASA physical status, intraoperative parameters of interventions and specificity of postoperative management of patients, clinical data, radiographic outcomes, complications were used. Dynamic evaluation was performed at the time from 24 to 48 months after the operation (median 32 months). As a result, it has been established that the use of minimally invasive dorsal decompressive-stabilizing interventions allows achieving better clinical outcomes and fewer perioperative complications than open transforaminal interbody spondylodesis and transpedicular stabilization with similar radiographic results of fusion formation and reduction of abnormal vertebral displacement. Low traumatic surgery in the main study group makes it possible to use a technique for treating degenerative spondylolisthesis in elderly patients.