As life expectancies increase, the geriatric population will increase, and the treatment of spinal diseases in the elderly will become even more commonplace. Treatment of spinal disorders in the geriatric patient population is a difficult challenge and involves numerous surgical, medical, and social issues. This review will provide an overview of the various spinal disorders particular to the geriatric patient population and will highlight certain concepts critical in the treatment of the spine in the geriatric population. Multiple factors, including poor tolerance of immobilization, medical comorbidities, use of multiple chronic medications, poor nutritional status, inadequate bone stock, and poor bone quality limit rigorous adherence to one treatment algorithm. These issues should be taken into consideration when formulating an individualized treatment plan that emphasizes early mobilization and functional rehabilitation. Goals, expectations, and surgical indications should be realistic and often will differ from those for a younger, healthier population. The use of a multidisciplinary approach will increase the likelihood of a successful treatment outcome and decrease the likelihood of potential complications.