OBJECTIVE: To investigate the significance and effect of total laminectomy decompression and internal spinal fixation in the treatment of degenerative lumbar spinal stenosis in the elderly. METHODS: The clinical data of 178 patients with degenerative lumbar spinal stenosis were compared and analyzed, and divided into two groups: total laminectomy decompression and decompression internal fixation. The Oswestry Dysfunction Index Questionnaire (ODI) was applied to assess the clinical outcomes at the first and last follow-up after surgery, and the improvement rate of the 2 ODI scores was calculated, and the intraoperative blood loss, operation time, postoperative back pain time, and postoperative leg pain time of the two groups were compared and analyzed. and postoperative leg pain time. RESULTS: Compared with the total laminectomy decompression plus internal spinal fixation group in the orthopedic department of Beijing Hospital Zhang Liang, there was no statistical difference in the improvement rate of the scores at the first and last follow-up postoperative years, and the operative time and operative bleeding were higher than those in the simple decompression group, and the postoperative back pain and leg pain time were significantly shorter. CONCLUSION: When degenerative lumbar spinal stenosis in the elderly was treated by total laminectomy decompression, the addition of internal spinal fixation significantly shortened the duration of postoperative symptoms, but did not significantly improve clinical outcomes, prolonged operative time, and increased intraoperative bleeding.