Entering the aging society, degenerative lumbar spine pathology has gradually become a common and frequent disease among middle-aged and elderly people, which seriously affects and disturbs their daily life and work and needs urgent treatment. Open lumbar spine surgery is one of the effective means to objectively and thoroughly resolve severe degenerative lumbar spine pathologies. However, as the volume of surgery increases, surgical malpractice or surgical misconceptions have gradually emerged and become widely recognized, thus providing a basis for avoiding these excessive or prophylactic surgeries. The lumbar spine has a special anatomy in which the nerve tissue is delicately protected in the intervening spinal canal and nerve root canal. The intervertebral disc is a component of the anterior wall of the spinal canal and nerve root canal and is located anterior to the spinal canal and nerve root canal; the lumbar articular eminence and ligamentum flavum are components of the posterior wall of the spinal canal and nerve root canal and are located posterior to the spinal canal and nerve root canal. The anterior intervertebral disc is at almost the same level as the posterior lumbar articular eminence and ligamentum flavum. In addition to the lumbar articular eminence and ligamentum flavum, the posterior structures of the lumbar spine include the lumbar spinous process, the supraspinous ligament, the interspinous ligament, and the bilateral laminae. The lumbar spinous process, supraspinous ligament, interspinous ligament, and bilateral laminae form the lumbar complex. The lumbar complex, the articular processes and the ligamentum flavum are connected together like a roof over a house, protecting the nerve tissue in the spinal canal and nerve root canal. At the same time, these posterior structures are like the steel cables that hold the poles in place and play an important role in maintaining the stability of the lumbar spine. Degenerative lumbar spine pathologies have a wide range of pathologies, including lumbar disc herniation, lumbar instability, and lumbar spinal stenosis, and their severe degenerative pathologies have common pathological features, namely: hyperplastic coalescence of the lumbar articular processes, hypertrophy of the ligamentum flavum, and degeneration of the intervertebral discs. The hyperplastic lumbar articular processes and the hypertrophic ligamentum flavum move from posterior to posterior, while the degenerated intervertebral disc moves from anterior to posterior, and the two pinch each other in the nerve tissue in the lumbar nerve root canal, thus inducing or aggravating clinical symptoms. This unique pathological change lies in the narrowing of the lumbar nerve root canal and in the narrowing and compression at the level of the disc-ligamentum flavum gap, rather than in the compression of the vertebral plate. If you want to make a miraculous recovery, you must do the right thing. Therefore, complete decompression of the lumbar radicular canal is the most critical measure to eliminate this pathological basis. The complete decompression of the lumbar radicular canal requires only the removal of the ligamentum flavum, part of the articular eminence and part of the vertebral plate, which is like opening a skylight on the roof and avoiding the “big reveal of the roof” by full laminectomy, minimizing the trauma of lumbar spine surgery. This is a minimally invasive practice in open surgery. The lumbar nerve root canal is completely decompressed without the need to remove the lumbar complex, which can be preserved! In this way, preserving the lumbar complex and getting out of the surgical misconception of total laminar decompression has led to a great change in the surgical treatment of lumbar degeneration from a conceptual point of view and a great progress from a surgical technique. Unfortunately, total laminectomy has been the standard decompression procedure for a long time. Extensive laminectomy destroys all posterior structures of the lumbar spine, compromises the stability of the lumbar spine, creates epidural scar adhesions, and decreases long-term outcomes. This surgical misconception of total laminectomy should be discarded! For different types of degenerative lumbar spine pathologies, including those requiring revision after lumbar spine surgery, a flexible combination of lumbar spine surgical procedures can be used to further achieve better outcomes with ease in clinical practice to reduce patient pain and maintain the health of the lumbar spine.