8 randomized controlled trials (852 patients) comparing an interspinous spacer (IS) against decompressive surgery (DS) for lumbar spinal stenosis were included in this systematic review and meta-analysis. Outcomes of interest included operative time, total blood loss, length of stay, incidence of adverse events, leg and back pain on a Visual Analog Scale (VAS), Oswestry Disability Index (ODI), Zurich Claudication Questionnaire (ZCQ) function and symptom subscales, foraminal height, and disc height decrease. Operative time, dural violation, and ZCQ physical function all favored the IS group, whereas the incidence of reoperation was significantly lower in the DS group. All other outcomes were similar between the two groups. The results of this study indicate that both IS and DS techniques are suitable for the treatment of lumbar spinal stenosis.