Most patients should have a strong idea of their goals when discussing the possibility of surgery. I believe managing surgical outcome expectations is a key point prior to agreeing to perform any neck or back surgery. Even with the newer less invasive procedures that get fantastic improvements in return to activity, some patients expectations cannot be met. I just returned from SMISS society meeting which is really the only legitimate spine group looking at less invasive surgery with peer-reviewed material. I hope my patients look at their publications and credentialling process.. I did present new material at this meeting and learned so much more that we can now offer our patients.