Proper patient selection is the key to successful surgical management. The presence of the appropriate symptoms, signs and imaging findings--along with the individual psychologic and socioeconomic factors--play a significant role in the selection process. Patient education is important so that the patient's expectations from surgery are aligned with the surgeon's expectations. When the patient has been properly selected, and there has been adherence to the decision-making principles, along with meticulous surgical technique, good outcomes can be expected with surgical management of patients with spinal stenosis.