As the number of elderly persons in the United States continues to increase, there will be an associated increase in age-related diseases, such as degenerative conditions of the lumbar spine. Elderly patients frequently present to their geriatrician or primary care provider with low back and leg pain. Spine surgery is one of several options the geriatric patient may consider for symptomatic relief, but the literature describing the safety and efficacy of spine surgery in older patients is inconclusive and at times confusing. The purpose of this article is to describe common degenerative conditions of the lumbar spine and to review the complications and outcomes of spine surgery in elderly patients, with particular attention to how they compare with those of younger patients. A better understanding of the risks and prognosis associated with these types of surgeries will enable more-informed decision-making by patients and physicians.