Data from 18 RCTs were systematically reviewed to determine an optimal treatment focused on walking ability for patients suffering from neurogenic claudication (NC) due to lumbar spinal stenosis. The evidence is presented in this review demonstrated low quality evidence that prostaglandins improved walking, and that surgical direct decompression was no better than non-operative treatment in improving walking ability. Additionally, there was very low quality evidence that calcitonin was no better than placebo or paracetamol regardless of mode of administration, that epidural injections improved walking distance up to 2 weeks compared to placebo, and that surgical indirect decompression improved walking ability compared to non-operative treatment. Lastly, there was low- to very low-quality evidence that gabapentin or methylcobalamin improved walking distance, and that physical therapy was no better in improving walking ability compared to no treatment, oral diclofenac plus home exercises, or combined manual therapy and exercise.