Lumbar spinal stenosis refers to the narrowing of the lumbar spinal canal due to abnormalities in the bony fibrous structures caused by various factors, resulting in a series of symptoms caused by compression of the dura mater and nerve roots. The etiology can be divided into developmental and secondary spinal stenosis. In developmental spinal stenosis, the narrowing of the anterior and posterior vertebral canal is more pronounced than the transverse meridians, the pedicle is shortened, and more segments are involved in the stenosis. Secondary spinal stenosis is mainly caused by degenerative changes in the spinal canal structure, slippage, trauma, and postoperative medical stenosis, etc. Other pathologies such as deformational osteitis, fluorosis, spinal deformity, posterior longitudinal ligament hypertrophy, ossification and ossification of the ligamentum flavum can also cause spinal stenosis, which can lead to increased pressure in the spinal canal and cauda equina ischemia. Nerve root compression can cause cauda equina symptoms or nerve root symptoms. The main clinical manifestations of lumbar spinal stenosis: Lumbar spinal stenosis is common in middle-aged people and above, more men than women. The onset of the disease is slow, often preceded by a history of chronic back pain. The typical clinical manifestation is intermittent claudication: patients often complain of pain or numbness and weakness in the lower extremities after walking a few meters or a few hundred meters, and the symptoms can be relieved after squatting and resting for a while, and they can continue walking again. But the symptoms appear again not far from the line, and so on repeatedly, but can ride a bicycle for a long time without symptoms. Symptoms of disc herniation can often be combined. No obvious signs …… How to treat lumbar spinal stenosis is a confusing problem for many patients. Because spinal stenosis mostly has a bony component, conservative treatment is usually ineffective in cases with heavy symptoms. Lumbar spinal stenosis is also a common indication for surgical treatment. The commonly used surgical procedures are laminectomy and nerve root decompression surgery. Since decompression removes part of the bone, it may cause instability of the lumbar spine. Therefore, the issue of bone graft fusion has been discussed more in recent years. There have been reports of lumbar spine slippage after decompression without simultaneous bone grafting fusion, and the lumbar spine slippage after decompression with total subtotal dissection is one of the reasons for poor postoperative results. However, simultaneous bone graft fusion complicates the operation, prolongs the operation time and increases the trauma. In recent years, with the improvement of surgeons’ surgical techniques, the operating room time has been significantly shortened and blood transfusion is no longer necessary. Therefore, the pros and cons of spinal fusion for patients remain to be confirmed by time observation. The following is an analysis of some specific situations and gives recommendations for surgical options for your reference. Postachini et al. reported the results of 16 cases with preoperative slippage and 8.6 years of postoperative follow-up. 6 of these cases were decompression only and 10 cases were fused at the same time, and it was found that those without fusion had more bone growth into the spinal canal and had less clinical results than those with simultaneous fusion. In the case of a sagittal position of the small joints, fusion fixation is recommended because the small joints cannot prevent lumbar spine slippage. Excessive removal of small joints Since resection or removal of >50% of small joints during surgery can cause instability, fusion fixation should be performed at the same time to prevent postoperative spinal instability. In lumbar spinal stenosis with scoliosis or kyphosis, extensive decompression may cause spinal instability or worsen deformity, and simultaneous fusion is recommended. In spinal stenosis with recurrent intervertebral discs, simultaneous fusion fixation should be considered. As reoperation requires additional resection of small joints to enlarge the lateral saphenous fossa and central spinal canal, leading to segmental instability. Surgical outcomes Surgical decompression of lumbar spinal stenosis is generally considered to have a good outcome; Katz et al. found that 75% of satisfactory results lasted 7 to 10 years with or without decompression and fusion, and 23% required reoperation. Predisposing factors for poor long-term outcomes after surgery include poor general condition and previous uniplanar laminar decompression. Recurrence of symptoms can be a recurrence of stenosis at the original surgical site, development of adjacent planes of stenosis, and low back pain with lumbar instability.