Low back and leg pain is one of the most common clinical symptoms. With the aging of the endocrine and immune functions of the body, the structure of the spine changes and loses its normal mechanical characteristics, which leads to an increased incidence of low back pain. Geriatric low back pain has the following clinical characteristics: (1) Slow onset, long duration and recurrent attacks. (2) Complex and diverse symptoms, mostly persistent or episodic and gradually increasing, and the symptoms cannot be relieved by bed rest. (3) The location of the lesion is multi-source and multi-segmental. (4) The etiology is mostly multifactorial compound type. (5) The treatment requires many factors to be considered, and surgery and anesthesia are risky and technically demanding. (6) The complexity of the condition leads to symptoms that are not completely relieved after surgery or recur after a period of time when the symptoms disappear, and corresponding medication or physical therapy is required. The common causes of low back pain include: spinal deformity; osteoporosis (the incidence of elderly people is more than 70%); lumbar disc herniation (the incidence is 4.7%-11.7%); lumbar spinal stenosis (the incidence of elderly people is about 40%); lumbar degenerative instability (accounting for about 15% of the incidence of elderly people); lumbar spondylolisthesis (accounting for 8%-10% of low back pain). For the treatment of elderly patients with lumbar and leg pain, most patients can reduce their symptoms or even improve significantly through conservative treatment. Conservative treatment is usually medicine, physical therapy, Chinese massage, acupuncture, etc. Under the guidance of the doctor, the corresponding conservative treatment measures should be taken according to the different causes and conditions. However, in the past, due to the level of medical technology, social attitudes and the patients’ own comorbidities, many elderly patients with low back pain could not receive surgery and were accompanied by pain for life. In developed countries in Europe and America, people pay attention to the quality of life, and at the same time the economic and medical conditions are developed, so in the treatment of low back and leg pain now tend to surgery, which has obtained very good results. At present, in China, with the development of economy, the continuous extension of life expectancy, the increase of economic income level, the change of concept, people’s demand for quality of life, and new surgical methods and surgical techniques, advanced internal fixation system, the progress of modern anesthesiology, and the further maturity of perioperative treatment, more and more patients have chosen surgical treatment. The main surgical modalities are: three-dimensional correction of spinal deformities and internal fixation surgery; vertebroplasty and posterior synovectomy; endoscopic minimally invasive surgery and so on. In conclusion, low back pain is a common and frequent disease, which can be caused by a variety of factors. Some patients can be treated by conservative treatment, but some patients need and may be relieved by surgery as early as possible. Therefore, patients who meet the indications for surgery should seize the last chance to restore a healthy life and avoid a long-term painful life by seeking effective surgical treatment early.