Background: Degenerative lumbar spinal stenosis is one of the common diseases in elderly, also may occur in younger ages. Usually presents with back pain, lower limbs pain and claudication pain. Diagnosis is confirmed by radiological studies such as plain X rays LSS, CT. LSS or MRI LSS. Objective: The aim of this prospective study was to evaluate the surgical versus conservative management of lumbar canal stenosis in old patient (age of 60 years old or more). Methods: A prospective comparative study was conducted on 100 old patients that were divide into two groups, each group 50 patients. The first 50 patients underwent surgical lumbar canal decompression and the other 50 patients underwent conservative management. Results: This study showed that elderly patients with moderate to severe lumbar stenosis without spondylolisthesis got benefit from surgery. They showed reduction in pain reported in the lower limbs (VAS Leg with p < 0.05) and improved function (Oswestry with p < 0.05) whoever there was no significance change regarding visual analogue scale (VAS) between the two groups. In addition, there was no significant difference between the result between 6 month and oneyear follow up. Conclusion: In patients with lumbar stenosis in old age, there was improvement in leg pain and function in patients underwent surgical posterior decompression but there was no difference in back pain compared to patients underwent conservative management.