Objectives: To investigate the value of lumbar fusion in the treatment of elderly patients with multi-segmental lumbar spinal stenosis. Methods: A retrospective analysis of 160 elderly patients with multi-segmental degenerative lumbar spinal stenosis from January 2014 to December 2017. In the observation group, the stenotic segment decompression and interbody fusion were performed after the responsibility segment was confirmed before operation. The control group underwent classic lumbar fusion. The VAS score, JOA score and ODI index were observed before and 3 months, 1 year and 2 years after operation. The operation time, blood loss, hospitalization day and complications were also recorded. Results: The operation time of the observation group was (120.45±31.25) min, the amount of bleeding (331.34±95.77) ml, and the hospitalization day (14.42±3.13) days, which were less than the operation time of the control group. 150.76±40.23) min, bleeding volume (410.52±100.35) ml, hospitalization day (18.43±4.28) days were statistically significant (P<0.05). There were 8 cases with complications (9.76%) in the observation group and 9 cases (11.53%) in the control group. There was no significant difference (P>0.05). There were no significant differences in VAS score, JOA score and ODI index between the two groups before and after 3 months, 1 year and 2 years after operation (P>0.05). The difference between the two groups was significantly improved compared with preoperative. There was a statistical difference (P<0.05). Conclusion: Responsible segmental fusion for the treatment of elder patients with multi-segment lumbar spinal stenosis can effectively shorten the operation time, reduce the amount of bleeding, reduce the hospitalization day, and achieve the expected clinical efficacy and improve the quality of life of patients.