The combination of ligament reconstruction with interlaminar or interspinous devices represents an innovative approach to treating degenerative spinal conditions, particularly in elderly patients with chronic low back pain and spinal stenosis. Recent studies, particularly those published after 2020, have offered deeper insights into the efficacy and safety of this approach. These include advancements in patient outcomes and surgical methodologies validated through longitudinal research and meta-analyses. This chapter examines the technical aspects, clinical outcomes, and biomechanical rationale of this combined approach. The integration of ligament reconstruction with dynamic stabilization devices provides a less invasive alternative to traditional fusion surgery while maintaining spinal stability and potentially reducing adjacent segment degeneration.