Operative Concept
Surgical decision-making in elderly patients
Older patients require planning that integrates neurologic need, medical risk, frailty, bone quality, and recovery goals.
Beyond technical feasibility
A technically possible operation may not be the appropriate operation if medical risk, frailty, or recovery capacity changes the clinical rationale for surgery.
Risk-specific planning
Bone quality, anticoagulation, cardiopulmonary status, delirium risk, and rehabilitation needs should be considered before choosing decompression, fusion, or nonoperative management.
Goal alignment
The plan should define realistic goals such as walking tolerance, radicular symptom relief, neurologic protection, and avoidance of unnecessary operative burden.