Five randomized controlled trials including 555 patients with degenerative lumbar spinal stenosis were included in this systematic review and meta-analysis comparing interspinous process device (IPD) vs. decompression surgery. Pooled outcomes of interest included Visual Analogue Scale (VAS) leg and back pain, Oswestry Disability Index (ODI), Zurich Claudication Questionnaire (ZCQ) physical function and symptom severity, complication rate, and reoperation rate. The pooled results showed no significant differences in VAS leg pain, VAS back pain, ODI scores, and ZCQ physical function between IPD and decompression surgery groups. However, decompression surgery was superior in ZCQ symptom severity, and the IPD group had a significantly higher reoperation rate. This study suggests that IPD is not superior to decompression surgery in clinical outcomes and further clinical trials are needed to validate these findings.