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Background Lumbar spinal stenosis (LSS) and low-grade degenerative spondylolisthesis are frequently associated with facet joint degeneration, considered the main cause of low back pain. Surgery is the treatment of choice in patients affected by LSS unresponsive to conservative treatment. The aim of this study was to evaluate the clinical and radiologic outcome of patients treated with posterior decompression and transfacet fixation for single-level LSS and facet joint degeneration.Methods A total of 25 patients between May 2015 and June 2016 affected by radiologically demonstrated one-level LSS with facet joint degeneration and grade I spondylolisthesis were included in this prospective study. All the patients underwent laminectomy, foraminotomy, and one-level facet fixation (Facet-Link, Inc., Rockaway, New Jersey, United States). Pre- and postoperative clinical (Oswestry Disability Index [ODI], Short Form-36 [SF-36]) and radiologic (radiographs, magnetic resonance imaging, computed tomography) data were collected and analyzed.Results Mean follow-up was 12 months. The L4-L5 level was involved in 18 patients (72%) and L5-S1 in 7 patients (28%); the average operative time was 80 minutes (range: 65-148 minutes), and the mean blood loss was 160 mL (range: 90-200 mL). ODI and SF-36 showed a statistically significant (p < 0.05) improvement at last follow-up.Conclusions Transfacet fixation is a safe and effective treatment option in patients with single-level LSS, facet joint degeneration, and mild instability.