Objective To evaluate the reliability of morphological grading of lumbar spinal stenosis and the presence of nerve root sedimentation sign and their correlation with symptoms，aiming to determine the method with greater clinical guidance value.Methods A retrospective analysis was conducted on clinical data of 346 patients with lumbar spinal stenosis who underwent surgery at a hospital affiliated with Southwest Medical University from January 2016 to December 2018，and 182 patients were finally included.Two independent observers used the three-point method for nerve root sedimentation sign and morphological grading of knee spinal stenosis on T2-weighted images to evaluate the narrowest segment.Intra-class correlation coefficients were used to evaluate the reliability，Spearman′s rank correlation coefficient was used to evaluate the correlation between the two methods and symptom indicators，and the correlation between the two evaluation methods was analyzed.Results In this study，there were 126 males and 56 females，with a me⁃ dian age of 69 years and a median course of 48 months.The distribution of the narrowest segment was 23 cases in L2-3，45 cases in L3-4，and 114 cases in L4-5.The intra-class correlation coefficient of morphological grading of lumbar spinal stenosis was 0.72-0.76，and the inter-class correlation coefficient was 0.69.The intra-class correlation coefficient of nerve root sedimentation sign was 0.82-0.85，and the inter-class correlation coefficient was 0.74.The nerve root sedimentation sign was correlated with the Oswestry Disability Index （rs = 0.28，P < 0.001），but not with leg pain VAS score（rs = 0.07，P = 0.30）or low back pain VAS score（rs = 0.11，P = 0.16）（P > 0.05）.The morphological grading was correlated with leg pain VAS score（rs = 0.18，P = 0.02）and Oswestry Disability Index（rs = 0.19，P = 0.01），but not with low back pain VAS score（rs =-0.03，P = 0.66）.There was a correlation between gait distance and morphologi⁃ cal grading（rs = 0.28，P < 0.001），but not with nerve root sedimentation sign.There was a strong correlation between morphological grading and nerve root sedimentation sign（rs = 0.61，P < 0.001）.Conclusion Morphological grading and nerve root sedimentation sign of lumbar spinal stenosis have excellent intra-observer reliability，and their correlation with symptoms is not strong.However，morpho⁃ logical grading is superior to nerve root sedimentation sign in evaluating lumbar spinal stenosis.