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Objective: To investigate the effects of Bu Yang Huan Wu Decoction on postoperative bone metabolism in patients with lumbar spinal stenosis complicated by cauda equina redundancy. Methods: A prospective, randomized, controlled study was conducted from March 2025 to December 2025 at the Department of Orthopedics and Traumatology of Bijie Traditional Chinese Medicine Hospital. Forty patients with lumbar spinal stenosis and cauda equina redundancy who underwent transforaminal lumbar interbody fusion (TLIF) were enrolled and randomly assigned to a control group and a study group, with 20 patients in each group. The control group received standard orthopedic treatment, while the study group received standard treatment supplemented with Buyang Huanwu Decoction. Bone density, serum levels of N-terminal propeptide of type I procollagen (PINP), β-C-terminal cross-linking telopeptide of type I collagen (β-CTX) , osteocalcin (OST), 25-hydroxyvitamin D (25OHD), parathyroid hormone (PTH), serum alkaline phosphatase (ALP), and serum creatinine (Scr). Results: Bone mineral density in all patients increased significantly compared to preoperative levels (P < 0.05), and the study group showed markedly better outcomes than the control group, with statistically significant differences (P < 0.05). Compared with the control group, the study group showed more pronounced increases in serum PINP, OST, 25OHD, and PTH, with statistically significant differences (P < 0.05); statistically significant decreases in β-CTX and Scr (P < 0.05); and a decrease in ALP that was not statistically significant (P > 0.05). Conclusion: Bu Yang Huan Wu Decoction demonstrates definite clinical efficacy in treating bone metabolism in patients with lumbar spinal stenosis complicated by cauda equina redundancy; it can significantly increase bone density and improve levels of bone metabolism markers.