To investigate the pathogenesis and surgical approach of degenerative lumbar scoliosis with spinal stenosis. METHODS: From January 2005 to December 2010, 96 patients with lumbar degenerative scoliosis with spinal stenosis were admitted to our department, including 31 men and 48 women; their ages ranged from 52 to 83 years, with an average of 59.7 years. According to the clinical symptoms, imaging and bone densitometry results, and physical quality, three types of surgical procedures were performed: in group A, 38 patients underwent full laminectomy, hemi-laminectomy or bilateral open decompression of the corresponding responsible segment; in group B, 23 patients underwent short-segment internal fixation, full laminectomy and bone graft fusion at the corresponding site; in group C, 35 patients underwent three-dimensional orthopedic treatment with multi-segment pedicle screws, full laminectomy at the stenosis site and intervertebral fusion. In group C, 35 groups underwent multi-segmental pedicle screw 3D orthopedics, total lamina decompression, intervertebral and posterior lateral bone graft fusion. RESULTS: In this group, the clinical efficiency was 87.5% in groups A and B, and the correction rate of cobb’s angle was 66.7% in group C. The improvement rate of lumbar anterior lordosis was 45.4%, and the clinical efficiency was 82.1%, with good implant fusion, no complications such as broken nails and rods and significant loss of correction rate. Conclusion: Due to the unique pathogenesis of degenerative lumbar scoliosis with spinal stenosis, adequate preoperative examination and determination of the lesion segment are the guarantee of successful surgery, and different surgical approaches can be selected for different cases.