With the aging of our society’s population, the number of patients with lumbar spinal stenosis in spine surgery is increasing. Neurological claudication due to lumbar spinal stenosis can seriously affect the physical function, quality of life and self-care ability of the elderly. For this group of elderly patients, in addition to some cases receiving surgical treatment, more patients choose non-surgical conservative treatment. However, there is not much clinical evidence on the exact outcome of conservative treatment for elderly patients with lumbar spinal stenosis with neurogenic claudication. In order to systematically evaluate the effectiveness of non-operative treatment in patients with lumbar spinal stenosis with neurological claudication, a systematic evaluation study was recently conducted by Carlo Ammendolia , DC, PhD, of the Toronto Institute for Health Policy Research, Canada, and the results of the study were published in a recent issue of Spine. The study searched databases including CENTRAL, MEDLINE, EMBASE, CINAHL, and ICL through January 2011 and included studies of randomized controlled trials published in English with at least one group of cases involving nonsurgical management. The risk of bias for each study was independently evaluated by two dedicated staff using 12 criteria. The quality of evidence was evaluated by applying the Grades of Recommendation Assessment, Development and Evaluation (GRADE) system. A total of 56 studies involving 1851 patients, including 21 trials, were included through screening of 8635 studies. The six clinical trials with lower levels of evidence showed that calcitonin was not more effective than placebo or paracetamol, regardless of the applied dosage form and mode of administration. In terms of improving walking distance, several small trials showed low levels of evidence for prostaglandins and very low levels of evidence for gabapentin or mecobalamin. Another clinical trial with a very low level of evidence showed that epidural steroid hormone injections improved pain, function, and quality of life for up to 2 weeks compared to home exercise or inpatient physical therapy. One pilot study with a low level of evidence showed short-term lower extremity pain relief and functional improvement in patients who participated in exercise compared to those who did not intervene. 6 studies with low or very low levels of evidence showed that multiple forms of non-surgical treatment measures were less effective compared to direct or indirect decompression (fusion or non-fusion) surgical treatment. With the data from this study, there is a lack of intermediate or high level GRADE evidence for non-surgical treatment, and therefore no definitive recommendations can be given to guide clinical practice. Given the expected exponential increase in the incidence of lumbar spinal stenosis with neurologic claudication, there is an urgent need for large, high-level clinical trials. Yan Yan Bian comments: The grasp of the indications for lumbar spinal stenosis surgery has been a hot topic of concern for the majority of physicians. Whether surgery is needed, when to operate, whether the patient has undergone strict conservative treatment before surgery, how well the patient tolerates the symptoms, the rate of progression of symptoms and the patient’s activity level and life expectancy, and whether the risk-benefit ratio of surgery is appropriate are all things that need to be considered, although this article provides a useful reference for the majority of patients Although the article provides a useful reference for a wide range of patients and physicians, individualized consideration and targeted treatment is still the main trend, and the pursuit of a different quality of life is also an important factor.