This chapter focuses on the surgical management of degenerative lumbar spine disease, particularly when conservative treatments fail. Effective surgical outcomes depend on patient selection and technique. Surgery is indicated after 6–12 weeks of ineffective conservative treatment, in cases of severe unmanageable pain, rapidly progressing neurological deficits, or cauda equina syndrome, which requires urgent decompression. “Red-flag” signs also necessitate surgical evaluation. This chapter outlines these criteria and emphasizes the importance of timely surgical intervention to improve patient outcomes.