[Surgical Treatment of Lumbar Spine Lesions: Collaboration with Neurologists from an Orthopedic Surgeon's Perspective].

Surgical indications for lumbar spine disorders should not be determined solely based on degenerative or stenotic magnetic resonance imaging findings. This article discusses how orthopedic spine surgeons evaluate lumbar pathology in collaboration with neurologists. The central issue is whether the patient's symptoms, neurological findings, and imaging abnormalities can be used to identify the responsible lesion that is likely to improve after surgery. Differential diagnoses, including cervical or thoracic myelopathy, peripheral neuropathy, motor neuron disease, vascular claudication, hip disease, tumors, and infection, must be considered, particularly in older patients with multiple coexisting disorders. The article also outlines orthopedic perspectives that influence surgical decision-making, including spinal instability, sagittal and coronal alignment, bone quality, frailty, sarcopenia, walking ability, and postoperative activities of daily living. The choice between decompression alone and decompression with fusion was reviewed together with perioperative management, rehabilitation, patient explanation, and shared decision-making. Complementary collaboration between orthopedic surgeons and neurologists may help clarify the responsible lesion, optimize referral timing, and avoid undertreatment and overtreatment.