This article critically reviews the current state of knowledge relating to outcome following decompressive surgery for lumbar spinal stenosis. Non-biased reviews of outcome are rare, follow-up times are not uniform and generally short, surgical techniques are not standardized. Rationale regarding the efficacy of concomitant spinal fusion is unconvincing. A procedure that is becoming ever more common in the neurosurgical armamentarium appears to be poorly described with respect to outcomes.