After the age of 60, virtually everyone complains of low back pain that is second only to an upper respiratory infection as a reason for employee absenteeism. And it's the single most common cause of long-term disability.

Although it is generally difficult to manage and medical relief can be elusive, for people with a condition called lumbar stenosis, surgical therapies can be extremely successful in reducing pain.

Lumbar stenosis disease affects one in 1,000 people over the age of 50 and is associated with a narrowing of the spinal canal, the central part of the bony spine that encases the spinal cord. This narrowing is caused by arthritis, degeneration of the vertebral disks and thickening of the ligaments that keep the vertebra in alignment and stable. In rare cases, injury to the spinal cord and tumors can lead to stenosis. The condition can either affect the neck (cervical spine) or low back (lumbar spine).

Patients with lumbar stenosis typically experience low back pain that comes on slowly and can vary in intensity from mild to severe. Pain occasionally radiates down into the legs and is made worse by walking. Many patients find relief by bending forward. If the compression is particularly serious, patients can also experience numbness, weakness, changes in gait and balance as well as loss of bowel and bladder control.

For people with severe pain where conservative treatments have been unsuccessful, or if there is evidence that nerve compression is leading to urinary incontinence or neurological deficits in the lower limbs, surgery is the best option to correct the stenosis, improve symptoms and ensure a better quality of life.

To date, there are three common surgical approaches to the treatment of lumbar stenosis. One is a procedure called decompression, which involves widening the narrowed spinal canal. Another is simple fusion of two vertebrae together, which helps relieve the pain by stabilizing the spine.

The third procedure involves fusing three or more vertebrae together and treating the front and the back of the spine. This operation is more extensive and complicated, but many back surgeons believe strongly that the success rates are so high that the more aggressive approach is preferred.

Although the total amount of surgeries for lumbar stenosis remained consistent between 2000 and 2007, the complex procedure became the dominant approach, increasing 15-fold from 1.3 to 19.9 surgeries for every 100,000 Medicare beneficiaries. A total of 32,152 of the complex surgeries were performed during the first 11 months of 2007 at a cost of $80,888 each, compared to a cost of $23,724 for the other two more minor approaches.

If complications were less and the outcomes were better, the increased expenditures would be worth the benefit. However, this is simply not the case. In terms of greater mobility, less pain and improved quality of life, the outcome was no better for the complex procedure and the complication rate was much higher. Life-threatening complications occurred in 2.3 percent of patients having either decompression or simple fusion, compared to 5.6 percent for those having the complex procedure.

These results offer an important message for patients and physicians. It is easy to justify more complicated therapies in the hope of achieving better outcomes, but often the aggressive approaches fail to meet our expectations. For patients, you must always understand the data behind your physician's recommended course of action. How long has the procedure been performed? What are the success rates? Is it more beneficial than a conservative approach?

For physicians, we must be vigilant in assessing, evaluating and re-evaluating the need for newer, more sophisticated therapies. In health care, we must all do our part to improve outcomes while simultaneously considering cost. And with a thoughtful approach to medicine, the two can coexist perfectly.

Dr. David Lipschitz is the author of the books, "Breaking the Rules of Aging" and "Dr. David's First Health Book of More Not Less."