Most elderly patients fear a loss of independence more than they fear death. Because the population is steadily increasing its average age, neurosurgeons especially in the spine field are challenged to maximize the independence of an increasingly elderly population. There is paucity of loterature involving the treatment of neurosurigical disorders except chronic subdural hematoma in geriatric patients. The most prevalent chronic conditions in the elderly include arthritis, sensory impairment, hypertension, cardiac conditions, and cognitive impairment. However, the elderly include arthritis, sensory impairment, hypertension, cardiac conditions, and congigive impairment. However, the presence of chronic condition per se has little effect on operative mortaliy. A detailed review of the medical literature fails to determine at what age a person is defined as elderly or geriatric. At this time, the most commonly utlized age is 65 years old. Age alone is not a contraindication to neurosurigical procedure. Rather, there are patient-specific, procedurespecific factors that are important to patient outcome. This paper reviews these issuse with respect to the elderly neurosurigical patient and addresses practical aspects for preoperative evaluation and postoperative care.