Background <p>Patients undergoing surgery for degenerative lumbar spinal diseases (DLSD) often experience impaired recovery due to acute pain, inflammation, muscular dysfunction, and residual numbness. Conventional pharmacotherapy relies heavily on nonsteroidal anti-inflammatory drugs (NSAIDs) and opioids, but their significant side effects limit widespread use. Consequently, non-pharmacological adjunctive therapies such as acupuncture are gaining increased attention.</p> Objective <p>This review critically synthesizes current evidence on the clinical efficacy of acupuncture in postoperative rehabilitation for DLSD and explores its underlying mechanisms.</p> Methods <p>A narrative review was conducted following a structured scoping framework. A targeted literature search was performed in PubMed, Embase, and Web of Science from inception to 2025. Key inclusion criteria comprised randomized controlled trials (RCTs), meta‑analyses, and mechanistic studies investigating acupuncture modalities for postoperative rehabilitation in DLSD. Exclusion criteria included non‑English articles and studies without clear outcome measures. Study selection and data extraction were performed independently by two reviewers, with discrepancies resolved by a third reviewer. This narrative review focuses on evidence synthesis and critical appraisal rather than formal meta‑analytic pooling.</p> Findings <p>Evidence from meta-analyses and RCTs indicates that acupuncture significantly reduces pain intensity (e.g., VAS scores), modulates inflammatory responses (e.g., reduces CRP and IL-6), improves muscle stiffness and fascial tension, and promotes functional recovery and quality of life (e.g., ODI scores). Notably, specific techniques, such as umbilical acupuncture combined with warm needling, show promise in alleviating refractory symptoms like residual numbness. The mechanisms of acupuncture are multifaceted, involving peripheral neuromodulation and local release of adenosine and endogenous opioids; segmental inhibition (mediated by enkephalins) and glial cell regulation at the spinal level; and activation of central descending pain inhibitory pathways (e.g., the PAG–RVM axis) via endogenous opioid and cannabinoid systems. Emerging research also proposes a potential biomechanical mechanism, whereby acupuncture may modulate fascial tension and disrupt pathological “fascial armor,” although this conceptual model remains preliminary and requires further validation.</p> Conclusion <p>Current available evidence suggests that acupuncture is a potentially safe and effective multimodal adjunctive therapy for postoperative rehabilitation in DLSD, addressing multiple complications through integrated neuro-immuno-endocrine and biomechanical mechanisms. However, conclusions are limited by heterogeneity in acupuncture techniques, variable study designs, and moderate overall evidence quality. Future research should prioritize large-scale, rigorously designed, long-term follow-up RCTs, promote standardization of acupuncture protocols, and conduct translational studies to further elucidate its mechanisms for personalized application.</p>