STUDY DESIGN Prospective noninterventional observation. OBJECTIVE To examine factors that influence a patient's real decision to accept the offer of surgery for lumbar spinal stenosis in a relatively controlled situation. SUMMARY OF BACKGROUND DATA A patient's decision to undergo spine surgery might be influenced by factors other than pathology. However, there is limited research exploring the decision. METHODS A study performed for other purposes recruited persons aged 55-90 years with medical record evidence of an offer of surgery for spinal stenosis by a university faculty surgeon. Inclusion criteria included neurogenic claudication, subjectively positive imaging, and difficulty walking 200 yards. Potential subjects with additional disabling conditions (eg, lower limb amputation), conditions that might mimic stenosis (eg, polyneuropathy), or some contraindications to invasive treatment (eg, anticoagulation) were excluded. Subjects filled out questionnaires on function, quality of life, pain, and health, and were examined by a spine surgeon masked to diagnostic category (Other recruits had back pain or no symptoms). Telephone follow-up 6-12 months later determined whether surgery was done. RESULTS Of 39 qualifying subjects, 20 followed through with surgery. A binary logistic regression revealed that significant factors that influence patient decision making included SF-36 measures of "Comparative Health" and "Role Limit Emotional" as well as the subject's overall perception of their quality of life. The combination of all 3 factors yielded a predictive model (P=0.031). Individually, however, only "Comparative Health" was significant and able to predict a decision to proceed with surgery (P=0.036). CONCLUSIONS In this population with significant disability, uncomplicated medical history, and a relatively clear diagnosis, the decision to accept surgical intervention was influenced by issues of perceived overall health and quality of life. Interventions to change real or perceived overall health may impact patient acceptance of surgery.