The purpose of this paper is to review the natural course of spinal stenosis in order to establish an optimal therapeutic plan. As the population becomes older, this condition is encountered more frequently. The numbers of detected cases were increased internationally with the diagnositc tools improved. Good knowledge of natural evolution and of the predictive factors influencing the course of the disease is crucial for the selection of methods of treatment. Unfortunately, in contrast with numerous reports of the results of surgical series, few studies have been reported on the natural evolution. However, results of the studies analyzed in this review suggest that a substantial proportion of patients do not automatically deteriorate and will remain unchanged or even improved by medical means. They also suggest that patients with severe baseline symptoms, block stenosis and degenerative spondylolisthesis tend to require surgical decompression.