Background <p>Degenerative lumbar spinal stenosis (DLSS) is a common condition associated with pain, functional limitation, and psychological distress. Although lumbar fusion surgery can relieve symptoms, postoperative recovery may be influenced by perioperative nursing care. This study aimed to evaluate the association between a structured perioperative nursing intervention pathway and recovery and psychological outcomes in patients undergoing lumbar spine surgery.</p> Methods <p>The final complete-case analysis of this non-concurrent single-center study included 140 patients with DLSS who underwent posterior lumbar interbody fusion (PLIF) or transforaminal lumbar interbody fusion (TLIF). Patients admitted from May to August 2024 were assigned to the control group (<i>n</i> = 70) and received routine nursing care, whereas those admitted from September 2024 to April 2025 were assigned to the intervention group (<i>n</i> = 70) and received a structured perioperative nursing intervention in addition to routine care. Clinical outcomes, including pain assessed by the Visual Analog Scale (VAS), functional disability assessed by the Oswestry Disability Index (ODI), and psychological status assessed by the Hospital Anxiety and Depression Scale (HADS), were evaluated preoperatively, on postoperative day 3 (POD3), at discharge, and at 1, 3, 6, and 12 months postoperatively. The primary outcome was VAS pain score at discharge, whereas other time-specific comparisons of VAS, ODI, HADS-A, and HADS-D were considered exploratory. No formal adjustment for multiple comparisons was applied to these exploratory time-specific analyses.</p> Results <p>Baseline demographic and clinical characteristics were comparable between groups. The intervention group had a shorter length of hospital stay than the control group (10.26 ± 4.86 vs. 12.31 ± 4.25 days, <i>P</i> = 0.009). At POD3, no between-group differences were observed in VAS, ODI, HADS-A, or HADS-D scores. For the prespecified primary outcome, the intervention group had a lower VAS score at discharge (3.57 ± 2.12 vs. 4.74 ± 2.42, <i>P</i> = 0.003). Exploratory unadjusted analyses showed selected between-group differences in functional and psychological scores during the first 6 postoperative months; these findings should be interpreted cautiously because no multiplicity adjustment was applied.</p> Conclusions <p>In this single-center, non-randomized, non-concurrent controlled study, the structured perioperative nursing intervention pathway was associated with a lower VAS pain score at the clinically defined discharge time point. Exploratory analyses suggested possible favorable functional and psychological trajectories at selected mid-term follow-up points; however, these findings should be considered hypothesis-generating because of the sequential cohort design and multiple unadjusted comparisons. Further prospective randomized studies are needed to confirm these associations.</p>