7 randomized controlled trials with a total of 894 patients with degenerative lumbar spinal stenosis were included in this systematic review and meta-analysis comparing decompression surgery combined with fusion (n=443) to decompression alone (n=451). The primary outcomes of interest included Oswestry Disability Index (ODI) scores, back and leg pain measured on a Visual Analog Scale (VAS) or Numeric Rating Scale (NRS), and patient satisfaction. Secondary outcomes of interest included the incidence of complications and reoperation, length of operation, blood loss, and length of hospitalization. The results of the meta-analysis found no differences in pain, ODI scores, or patient satisfaction between the two groups. Decompression plus fusion was associated with greater blood loss, longer length of stay, and a greater likelihood of complications compared to decompression alone.