Summary:As the elder population lives longer, symptomatic lumbar stenosis will become a more frequent clinical entity. Once surgical decompression is considered, controversy exists as to when to fuse. In this study, 206 patients with symptomatic lumbar stenosis were treated initially by decompression only. After a mean follow-up of 28 months, six patients needed a subsequent operation for a fusion. A common denominator was not determined except for a possible grade II spondylolisthesis. Fusion with decompression is not routinely recommended unless grade II spondylolisthesis is co-existent.