I have recently completed a review of my last 1000 surgeries and specifically looked at results. Clearly the use of smaller implants and less hardware has showned to make a difference. Patients should understand that maintaining stabilility after decompression does require inserting devices. When bone is remove the spine will start to collapse in a significant number of surgical cases unless there is insertion of implants. Fortunately, we use smaller incisions in both the neck and lumbar spine. I try using models to explain the insertion process to each patient. I still maintain the majority of patients do not need any surgery.