ORIGINAL CONTRIBUTION Trends, Major Medical Complications, and Charges Associated With Surgery for Lumbar Spinal Stenosis in Older Adults

IN PLANNING SPINE OPERATIONS, SURgeons have wide discretion. For pain-related surgery, consensus on indications for specific procedures (eg, decompression alone or decompression plus fusion) is generally lacking despite randomized trials for some condition and procedure combinations. Furthermore, individual surgeon preferences may outweigh patient and disease characteristics in choosing procedures. Such choices are important because greater invasiveness is associated with greater complications, health care use, and mortality but generally similar clinical benefit. Risks of spine surgery are particularly important in older adults, for whom stenosis is the most common surgical indication. Symptomatic lumbar stenosis results from progressive degenerative changes in intervertebral joints and ligamentous structures, leading to spinal canal and neural foraminal narrowing. Diagnosis and treatment require complex judgments integrating data from imaging, clini-