Degenerative lumbar spine disease is a common disease among the elderly, and most of the patients are over 65 years old, and there is no lack of patients over 80 years old who have undergone surgical treatment. However, many elderly people have the impression that it is normal for people to have back pain in old age, and have never thought of surgical treatment. Not long ago, we performed lumbar spine surgery on a 78-year-old patient. The preoperative evaluation of his heart showed that his cardiac ejection fraction was 49%, and surgery was generally not recommended. At that time, I tried to advise the patient to give up the surgery considering the high risk of surgery, but the patient insisted on the surgery. With the support of the anesthesiology department, the surgery was successful. The patient was discharged 3 days after surgery with a hospitalization cost of 30,000 RMB. Through this case of surgery, reviewing the elderly patient’s medical history, the process of seeking medical treatment, the psychological changes, to the final decision to operate, I deeply realize how difficult it is for the elderly to make the decision to operate, and how difficult and courageous it is! They not only suffer from the pain of the disease, but also have to face a variety of treatment options, face the doctor’s various conversations to sign, and consider the worries of their elderly companions and children at home. Elderly patients who consider surgery basically have symptoms that are getting worse and worse, to the point where they are really hard to tolerate. Many of these patients make up their minds to have surgery because their neighbors or relatives have had good results after surgery. However, there are also those who have given up surgery and delayed their condition because they have heard of someone who had poor results after surgery. Therefore, I would like to tell elderly patients that they should have surgery when they have degenerative lumbar spine diseases, and as long as they are well-prepared for the surgery, age is no longer a decisive factor in deciding whether or not they can have the surgery. Intermittent claudication is a typical symptom Generally speaking, lumbar pain, especially when accompanied by radiating pain in the lower limbs, is often caused by lumbar degenerative diseases. Some patients also have numbness in the lower limbs, often in the calf and dorsal part of the foot. It is important to note that joint problems can also cause pain in the lower limbs, but predominantly in the joint area and often not accompanied by low back pain. Intermittent claudication means that after walking for a certain distance, pain, numbness, weakness and other discomforts of both lower limbs appear, and it is necessary to stop and rest in order to continue to walk; with the development of the disease, the walking distance is getting shorter and shorter, and it is even necessary to stop after walking for 10 meters. This kind of intermittent claudication is only manifested in walking, the patient can ride a bicycle, will not cause discomfort. For the treatment of lumbar degenerative diseases, most patients can reduce their symptoms through conservative treatment, and some even improve significantly. Conservative treatment is generally drugs, physical therapy, Chinese massage, acupuncture, etc., but should be under the guidance of the doctor, according to different causes and conditions to take appropriate conservative treatment measures. It should be noted that there are many conservative treatment methods, especially the use of massage needs to be carried out in formal institutions; for patients with lumbar spondylolisthesis, massage has the possibility of aggravating the condition. For patients with lumbar spondylolysis, massage has the potential to aggravate the condition. For patients who have not received regular conservative treatment, surgery is the only way out. In developed countries in Europe and the United States, people pay attention to the quality of life, once intermittent claudication and other symptoms are now more inclined to surgical treatment, which can get very good results. Conservative treatment is ineffective when the need for surgery Most of the lumbar degenerative diseases caused by lumbar pain is often manifested as good and bad, recurring, especially in the winter and spring seasons, the patient’s symptoms due to the influence of the external environment and aggravation. So, what kind of patients with low back pain need surgery? First, patients who are ineffective with conservative treatment usually need surgery. Conservative treatment is usually effective for most patients, and if regular conservative treatment is ineffective, surgery should be considered. Secondly, alternating sciatica, nerve damage is progressive aggravation, numbness of both lower limbs and perineum, decreased or disappeared sensation, weakness of urination and defecation, urinary retention, urinary and fecal incontinence, and impotence in men can also occur. This situation requires early surgery, delayed surgery often causes irreversible nerve damage. Thirdly, it is accompanied by symptoms of intermittent claudication, with walking distance getting shorter and shorter. Early surgical intervention can improve the patient’s quality of survival, but of course, this type of surgery requires careful evaluation. Non-fusion minimally invasive surgery preserves function Surgery for lumbar degenerative diseases is roughly categorized into three types, i.e., decompression alone, decompression + fusion, and minimally invasive surgery. The most widely used surgical procedure for lumbar degenerative disease is decompression + pedicle screws for internal fixation and fusion. Laminectomy decompression and nerve root decompression is the standard procedure for treating lumbar spinal stenosis or lumbar disc herniation, i.e., by removing the laminae, articular eminences, ligaments, and other structures to expand the volume of the spinal canal and relieve nerve compression. Since decompression destabilizes the spine, internal fixation fusion with transpedicular screws is performed at the same time as decompression. Fusion means that two or more segments of the vertebrae are artificially attached and fixed together as a single unit, which increases stability but results in a loss of mobility of the spine. Internal fixation surgery is expensive, with long recovery times and many complications for the patient after surgery. In recent years, minimally invasive, nonfusion surgery has been a major trend in surgical spine surgery, and new minimally invasive procedures for degenerative lumbar spine diseases are emerging. With the development of neurosurgery in spinal surgery, the concept of minimally invasive runs through it, and the routine use of microscopes and grinding drills is the basis and condition for minimally invasive surgery. The procedure is performed under a microscope, using a high-speed grinding drill to remove part of the patient’s hemivertebrae without injuring the lesser joints and spinous processes, and biting away the thickened ligamentum flavum in the spinal canal from different angles, enlarging the lateral crypt on the affected side, and resulting in a more adequate decompression in the spinal canal. Minimally invasive surgery is characterized by the preservation of the spinous processes and small joints, and the surgery is less invasive, with fewer complications, and can be tolerated by the vast majority of elderly patients. The procedure is function-preserving and has little effect on the stability of the spine. Patients are able to get down to the floor the day after surgery, hospitalization time is greatly reduced, and the costs associated with the procedure are significantly lower.