What to Expect When the Unexpected Becomes Expected: Harmonic Surprise and Preference Over Time in Popular Music.

Previous work demonstrates that music with more surprising chords tends to be perceived as more enjoyable than music with more conventional harmonic structures. In that work, harmonic surprise was computed based upon a static distribution of chords. This would assume that harmonic surprise is constant over time, and the effect of harmonic surprise on music preference is similarly static. In this study we assess that assumption and establish that the relationship between harmonic surprise (as measured according to a specific time period) and music preference is not constant as time goes on. Analyses of harmonic surprise and preference from 1958 to 1991 showed increased harmonic surprise over time, and that this increase was significantly more pronounced in preferred songs. Separate analyses showed similar increases over the years from 2000 to 2019. As such, these findings provide evidence that the human perception of tonality is influenced by exposure. Baseline harmonic expectations that were developed through listening to the music of "yesterday" are violated in the music of "today," leading to preference. Then, once the music of "today" provides the baseline expectations for the music of "tomorrow," more pronounced violations-and with them, higher harmonic surprise values-become associated with preference formation. We call this phenomenon the "Inflationary-Surprise Hypothesis." Support for this hypothesis could impact the understanding of how the perception of tonality, and other statistical regularities, are developed in the human brain.

Noninvasive brain stimulation to lateral prefrontal cortex alters the novelty of creative idea generation.

Theories of the processes involved in creative cognition posit that cognitive control has a negative effect on creative idea generation but a positive effect on creative idea evaluation. Brain stimulation research has started to examine empirically the effects of cognitive control, with several reports of decreased cognitive control facilitating creative ideation. Such studies have shown how decreased cognitive control mechanisms facilitate creative idea generation, potentially by allowing participants access to less inhibited weaker-related associations, thereby increasing novelty. In the current study, we advance this line of work by investigating how cognitive control affects creative thinking, potentially inhibiting or facilitating novel idea generation based on task demands. Participants read sentences with the final word missing and were instructed to complete the sentence with an uncommon (but appropriate) ending. Participants performed this task while undergoing either anodal (excitatory), cathodal (inhibitory), or sham (control) transcranial direct current stimulation over their left prefrontal cortex. These responses were then rated for their novelty and appropriateness by an independent sample of raters. We found that anodal stimulation increased the appropriateness and decreased the novelty of participants' responses. Contrary to previous studies, we did not find that cathodal stimulation increased the novelty of participants' responses, which may be due to the nature of our task. Overall, we demonstrate how cognitive control mechanisms may inhibit novel idea generation.

Dual-process contributions to creativity in jazz improvisations: An SPM-EEG study.

Conflicting theories identify creativity either with frontal-lobe mediated (Type-2) executive control processes or (Type-1) associative processes that are disinhibited when executive control is relaxed. Musical (jazz) improvisation is an ecologically valid test-case to distinguish between these views because relatively slow, deliberate, executive-control processes should not dominate during high-quality, real-time improvisation. In the present study, jazz guitarists (n â€‹= â€‹32) improvised to novel chord sequences while 64-channel EEGs were recorded. Jazz experts rated each improvisation for creativity, technical proficiency and aesthetic appeal. Surface-Laplacian-transformed EEGs recorded during the performances were analyzed in the scalp-frequency domain using SPM12. Significant clusters of high-frequency (beta-band and gamma-band) activity were observed when higher-quality versus lower-quality improvisations were compared. Higher-quality improvisations were associated with predominantly posterior left-hemisphere activity; lower-quality improvisations were associated with right temporo-parietal and fronto-polar activity. However, after statistically controlling for experience (defined as the number of public performances previously given), performance quality was a function of right-hemisphere, largely right-frontal, activity. These results support the notion that superior creative production is associated with hypofrontality and right-hemisphere activity thereby supporting a dual-process model of creativity in which experience influences the balance between executive and associative processes. This study also highlights the idea that the functional neuroanatomy of creative production depends on whether creativity is defined in terms of the quality of products or the type of cognitive processes involved.

Enabling creative collaboration for all levels of learning.

A potential path for enabling greater creativity and collaboration is through increased arts and science, technology, engineering, and mathematics (STEM) integration in education and research. This approach has been a growing discussion in US national forums and is the foundation of the science, technology, engineering, and mathematics plus arts and design (STEAM) education movement. Developing authentic artistic integrations with STEM fields (or vice versa) is challenging, particularly in higher education, where traditional disciplinary structures and incentives can impede the creation of integrated programs. Measuring and assessing the outcomes of such integration efforts can be even more challenging, since traditional metrics do not necessarily capture new opportunities created for students and faculty, and the greatest impact may occur over a long period (a career). At Drexel University, we created the Expressive & Creative Interaction Technologies (ExCITe) Center as a standalone institute to pursue and enable such transdisciplinary arts-STEM collaborations, particularly with external arts and education partners. In this perspectives paper, we highlight a range of projects and outcomes resulting from such external collaborations, including graduate research with professional artists, undergraduate student work experiences, and STEAM-based education programs for kindergarten through 12th-grade (K-12) students. While each project has its own specific objectives and outcomes, we believe that they collectively demonstrate this integrated transdisciplinary approach to be impactful and potentially transformative for all levels of learning.

A Statistical Analysis of the Relationship between Harmonic Surprise and Preference in Popular Music.

Studies have shown that some musical pieces may preferentially activate reward centers in the brain. Less is known, however, about the structural aspects of music that are associated with this activation. Based on the music cognition literature, we propose two hypotheses for why some musical pieces are preferred over others. The first, the Absolute-Surprise Hypothesis, states that unexpected events in music directly lead to pleasure. The second, the Contrastive-Surprise Hypothesis, proposes that the juxtaposition of unexpected events and subsequent expected events leads to an overall rewarding response. We tested these hypotheses within the framework of information theory, using the measure of "surprise." This information-theoretic variable mathematically describes how improbable an event is given a known distribution. We performed a statistical investigation of surprise in the harmonic structure of songs within a representative corpus of Western popular music, namely, the McGill Billboard Project corpus. We found that chords of songs in the top quartile of the Billboard chart showed greater average surprise than those in the bottom quartile. We also found that the different sections within top-quartile songs varied more in their average surprise than the sections within bottom-quartile songs. The results of this study are consistent with both the Absolute- and Contrastive-Surprise Hypotheses. Although these hypotheses seem contradictory to one another, we cannot yet discard the possibility that both absolute and contrastive types of surprise play roles in the enjoyment of popular music. We call this possibility the Hybrid-Surprise Hypothesis. The results of this statistical investigation have implications for both music cognition and the human neural mechanisms of esthetic judgments.

Anodal tDCS to Right Dorsolateral Prefrontal Cortex Facilitates Performance for Novice Jazz Improvisers but Hinders Experts.

Research on creative cognition reveals a fundamental disagreement about the nature of creative thought, specifically, whether it is primarily based on automatic, associative (Type-1) or executive, controlled (Type-2) processes. We hypothesized that Type-1 and Type-2 processes make differential contributions to creative production that depend on domain expertise. We tested this hypothesis with jazz pianists whose expertise was indexed by the number of public performances given. Previous fMRI studies of musical improvisation have reported that domain expertise is characterized by deactivation of the right-dorsolateral prefrontal cortex (r-DLPFC), a brain area associated with Type-2 executive processing. We used anodal, cathodal, and sham transcranial direct current stimulation (tDCS) applied over r-DLPFC with the reference electrode on the contralateral mastoid (1.5 mA for 15 min, except for sham) to modulate the quality of the pianists' performances while they improvised over chords with drum and bass accompaniment. Jazz experts rated each improvisation for creativity, esthetic appeal, and technical proficiency. There was no main effect of anodal or cathodal stimulation on ratings compared to sham; however, a significant interaction between anodal tDCS and expertise emerged such that stimulation benefitted musicians with less experience but hindered those with more experience. We interpret these results as evidence for a dual-process model of creativity in which novices and experts differentially engage Type-1 and Type-2 processes during creative production.

Health Care Issues for Children and Adolescents in Foster Care and Kinship Care.

Children and adolescents involved with child welfare, especially those who are removed from their family of origin and placed in out-of-home care, often present with complex and serious physical, mental health, developmental, and psychosocial problems rooted in childhood adversity and trauma. As such, they are designated as children with special health care needs. There are many barriers to providing high-quality comprehensive health care services to children and adolescents whose lives are characterized by transience and uncertainty. Pediatricians have a critical role in ensuring the well-being of children in out-of-home care through the provision of high-quality pediatric health services in the context of a medical home, and health care coordination and advocacy on their behalf. This technical report supports the policy statement of the same title.

Use of Psychopharmacologic Medications in Adolescents With Restrictive Eating Disorders: Analysis of Data From the National Eating Disorder Quality Improvement Collaborative.

PURPOSE: Psychopharmacologic medications are often prescribed to patients with restrictive eating disorders (EDs), and little is known about the frequency of use in adolescents. We examined the use of psychopharmacologic medications in adolescents referred for treatment of restrictive ED, potential factors associated with their use, and reported psychiatric comorbidities. METHODS: Retrospective data from the initial and 1-year visits were collected for patients referred for evaluation of restrictive ED at 12 adolescent-based ED programs during 2010 (Group 1), including diagnosis, demographic information, body mass index, prior treatment modalities, and psychopharmacologic medications. Additional data regarding patients' comorbid psychiatric conditions and classes of psychopharmacologic medications were obtained from six sites (Group 2). RESULTS: Overall, 635 patients met inclusion criteria and 359 had 1-year follow-up (Group 1). At intake, 20.4% of Group 1 was taking psychopharmacologic medication and 58.7% at 1 year (p ≤ .0001). White, non-Hispanic race (p = .020), and prior higher level of care (p < .0001) were positively associated with medication use at 1 year. Among Group 2 (n = 256), serotonin reuptake inhibitors/serotonin-norepinephrine reuptake inhibitors use was most common, and 62.6% had a reported psychiatric comorbidity. Presence of any psychiatric comorbidity was highly associated with medication use; odds ratio, 10.0 (5.6, 18.0). CONCLUSIONS: Adolescents with restrictive ED treated at referral centers have high rates of reported psychopharmacologic medication use and psychiatric comorbidity. As more than half of this referral population were reported to be taking medication, continued investigation is warranted to ensure the desired outcomes of the medications are being met.

Predictors of outcome at 1 year in adolescents with DSM-5 restrictive eating disorders: report of the national eating disorders quality improvement collaborative.

PURPOSE: The National Eating Disorders Quality Improvement Collaborative evaluated data of patients with restrictive eating disorders to analyze demographics of diagnostic categories and predictors of weight restoration at 1 year. METHODS: Fourteen Adolescent Medicine eating disorder programs participated in a retrospective review of 700 adolescents aged 9-21 years with three visits, with DSM-5 categories of restrictive eating disorders including anorexia nervosa (AN), atypical AN, and avoidant/restrictive food intake disorder (ARFID). Data including demographics, weight and height at intake and follow-up, treatment before intake, and treatment during the year of follow-up were analyzed. RESULTS: At intake, 53.6% met criteria for AN, 33.9% for atypical AN, and 12.4% for ARFID. Adolescents with ARFID were more likely to be male, younger, and had a longer duration of illness before presentation. All sites had a positive change in mean percentage median body mass index (%MBMI) for their population at 1-year follow-up. Controlling for age, gender, duration of illness, diagnosis, and prior higher level of care, only %MBMI at intake was a significant predictor of weight recovery. In the model, there was a 12.7% change in %MBMI (interquartile range, 6.5-19.3). Type of treatment was not predictive, and there were no significant differences between programs in terms of weight restoration. CONCLUSIONS: The National Eating Disorders Quality Improvement Collaborative provides a description of the patient population presenting to a national cross-section of 14 Adolescent Medicine eating disorder programs and categorized by DSM-5. Treatment modalities need to be further evaluated to assess for more global aspects of recovery.

Characteristics of avoidant/restrictive food intake disorder in children and adolescents: a "new disorder" in DSM-5.

PURPOSE: To evaluate the DSM-5 diagnosis of Avoidant/Restrictive Food Intake Disorder (ARFID) in children and adolescents with poor eating not associated with body image concerns. METHODS: A retrospective case-control study of 8-18-year-olds, using a diagnostic algorithm, compared all cases with ARFID presenting to seven adolescent-medicine eating disorder programs in 2010 to a randomly selected sample with anorexia nervosa (AN) and bulimia nervosa (BN). Demographic and clinical information were recorded. RESULTS: Of 712 individuals studied, 98 (13.8%) met ARFID criteria. Patients with ARFID were younger than those with AN (n = 98) or BN (n = 66), (12.9 vs. 15.6 vs. 16.5 years), had longer durations of illness (33.3 vs. 14.5 vs. 23.5 months), were more likely to be male (29% vs. 15% vs. 6%), and had a percent median body weight intermediate between those with AN or BN (86.5 vs. 81.0 and 107.5). Patients with ARFID included those with selective (picky) eating since early childhood (28.7%); generalized anxiety (21.4%); gastrointestinal symptoms (19.4%); a history of vomiting/choking (13.2%); and food allergies (4.1%). Patients with ARFID were more likely to have a comorbid medical condition (55% vs. 10% vs. 11%) or anxiety disorder (58% vs. 35% vs. 33%) and were less likely to have a mood disorder (19% vs. 31% vs. 58%). CONCLUSIONS: Patients with ARFID were demographically and clinically distinct from those with AN or BN. They were significantly underweight with a longer duration of illness and had a greater likelihood of comorbid medical and/or psychiatric symptoms.

Distribution of eating disorders in children and adolescents using the proposed DSM-5 criteria for feeding and eating disorders.

PURPOSE: To determine the distribution of eating disorders (ED) in children and adolescents comparing the fourth edition of the Diagnostic and Statistical Manual (DSM) to the proposed fifth edition DSM criteria. METHODS: A total of 215 consecutive patients (15.4 ± 3.3 years) presenting for initial ED evaluation to adolescent medicine physicians from six institutions were assigned ED diagnoses using current DSM-IV criteria as well as proposed DSM-5 criteria. RESULTS: Diagnoses of anorexia nervosa and bulimia nervosa increased using the proposed DSM-5 criteria (from 30.0% to 40.0% and from 7.3% to 11.8%, p < .001). Approximately 14% of patients received the presumptive DSM-5 diagnosis of avoidant/restrictive food intake disorder. Cases of ED not otherwise specified decreased from 62.3% to 32.6% (p < .001). CONCLUSIONS: Proposed DSM-5 criteria substantially decreased the frequency of ED not otherwise specified diagnoses and increased the number of cases of anorexia nervosa and bulimia nervosa in a population of young patients presenting for ED treatment. Avoidant/restrictive food intake disorder appears to be a significant diagnosis.

An eleven site national quality improvement evaluation of adolescent medicine-based eating disorder programs: predictors of weight outcomes at one year and risk adjustment analyses.

PURPOSE: This quality improvement project collected and analyzed short-term weight gain data for patients with restrictive eating disorders (EDs) treated in outpatient adolescent medicine-based ED programs nationally. METHODS: Data on presentation and treatment of low-weight ED patients aged 9-21 years presenting in 2006 were retrospectively collected from 11 independent ED programs at intake and at 1-year follow-up. Low-weight was defined as < 90% median body weight (MBW) which is specific to age. Treatment components at each program were analyzed. Risk adjustment was performed for weight gain at 1 year for each site, accounting for clinical variables identified as significant in bivariate analyses. RESULTS: The sites contained 6-51 patients per site (total N = 267); the mean age was 14.1-17.1 years; duration of illness before intake was 5.7-18.6 months; % MBW at intake was 77.5-83.0; and % MBW at follow-up was 88.8-93.8. In general, 40%-63% of low weight ED subjects reached ≥90% MBW at 1-year follow-up. At intake, patients with higher % MBW (p = .0002) and shorter duration of illness (p = .01) were more likely to be ≥90% MBW at follow-up. Risk-adjusted odds ratios controlled for % MBW and duration of illness were .8 (.5, 1.4)-1.3 (.3, 3.8), with no significant differences among sites. CONCLUSION: A total of 11 ED programs successfully compared quality improvement data. Shorter duration of illness before intake and higher % MBW predicted improved weight outcomes at 1 year. After adjusting for risk factors, program outcomes did not differ significantly. All adolescent medicine-based ED programs were effective in assisting patients to gain weight.

Identification and management of eating disorders in children and adolescents.

The incidence and prevalence of eating disorders in children and adolescents has increased significantly in recent decades, making it essential for pediatricians to consider these disorders in appropriate clinical settings, to evaluate patients suspected of having these disorders, and to manage (or refer) patients in whom eating disorders are diagnosed. This clinical report includes a discussion of diagnostic criteria and outlines the initial evaluation of the patient with disordered eating. Medical complications of eating disorders may affect any organ system, and careful monitoring for these complications is required. The range of treatment options, including pharmacotherapy, is described in this report. Pediatricians are encouraged to advocate for legislation and policies that ensure appropriate services for patients with eating disorders, including medical care, nutritional intervention, mental health treatment, and care coordination.

Eating disorders and the oral and maxillofacial surgeon.

Perhaps the most challenging of all patients seeking treatment with the oral and maxillofacial surgeon (OMS) are those with eating disorders (EDs). Complex psychiatric illnesses, with their associated and significant medical sequelae, make a thorough knowledge of these disorders critical in the approach, evaluation, treatment planning, and surgical outcome in this expanding population of patients. Whether surgery for patients with EDs is elective in nature or unplanned, challenges are faced in all aspects of their care, from diagnosis to preoperative preparation, surgery, and treatment. This article identifies and outlines issues of importance for the OMS when encountering patients with known or suspected EDs and provides guidance in the management of their outpatient or inpatient treatment.

Arterial diameters on catheter and computed tomographic angiography.

BACKGROUND: The diagnosis of cerebral vasospasm is hampered by lack of an accurate, noninvasive test. Computed tomographic angiography (CTA) may be useful but the correlation between arterial diameters determined from catheter digital subtraction angiography (DSA) and CTA over a range of artery sizes would need to be determined to show this. The purpose of this study was to determine the correlation between artery diameters measured on DSA and multidetector CTA. METHODS: Two hundred forty artery diameters were measured in DSA and CTA from 46 patients who underwent both studies within 12 hours of each other. Axial cross section, maximum intensity projection, and volume-rendered images were measured and compared by linear correlation. Two independent readers measured CTA diameters to determine interobserver variability by linear correlation. Values also were categorized and compared by χ(2) and κ statistics. Analysis was repeated with unmeasurable arteries assigned a value of 0. RESULTS: There were significant correlations between arterial diameters measured on DSA and those from CTA measured by any method (R(2) ranging from 0.45 to 0.76, P < .0001), although there was a tendency for the slope of this relationship to be less than 1, indicating underestimation of diameter of large and overestimation of diameter of small arteries with CTA. Computed tomographic angiography diameters also correlated significantly between the 2 reviewers with higher values often when unmeasureable arteries were assigned a value of 0 (κ = 0.23-0.55, P < .0001). CONCLUSION: Arterial diameters measured on multidetector CTA correlate well with those determined from DSA and should permit use of CTA for quantitative study of cerebral vasospasm and other conditions requiring accurate measurement of arterial diameters. The limitation of CTA remains the inability to measure some arteries due to artifact.

Obesity and self-reported outcome after minimally invasive lumbar spinal fusion surgery.

OBJECTIVE: Many patients undergoing lumbar spine fusion are overweight or obese. The relationship between body habitus and outcome after lumbar spine fusion surgery is not well defined. METHODS: We analyzed a prospectively maintained database of self-reported pain and quality of life measures, including Visual Analog Scale pain score, Short Form 36, and Oswestry Disability Index. We selected patients undergoing minimally invasive transforaminal lumbar interbody fusion between September 2002 and June 2006 at a single institution. We used linear regression models and mixed-effects linear models to examine the relationships between body habitus and self-reported outcomes. RESULTS: The analysis identified 110 patients meeting the study criteria, with a median follow-up period of 14.8 months. The mean age was 56 years, mean height was 169 cm, and mean weight was 82.2 kg. The mean body mass index (BMI) was 28.7 kg/m2; 31% of patients were overweight (BMI, 25-29.9), and 32% of patients were obese (BMI, >30). Linear regression analysis did not identify a correlation between weight or BMI and pre- and postsurgery changes in any of the outcome measures. The significant findings observed in the mixed-effects linear models were that the changing patterns of Short Form 36 Body Pain subscale and Short Form 36 Vitality subscale varied significantly by category of BMI (P = 0.01 and P = 0.002, respectively), but not significantly if continuous BMI was used (P = 0.53 and P = 0.46, respectively). BMI correlated marginally with estimated blood loss (P = 0.08), but not operative time, length of hospital stay, or complications. CONCLUSION: Among this cohort of minimally invasive lumbar fusion patients, body habitus measured by BMI, weight, or height did not have a significant relationship with most self-reported outcome measures, operative time, length of hospital stay, or complications. Obesity should not be considered a contraindication to minimally invasive lumbar spinal fusion surgery.

Extranodal hairy cell leukemia presenting in the lumbar spine.

The authors report on a 54-year-old man who presented with a lumbar vertebral body lesion and an adjacent epidural lesion that was found to be hairy cell leukemia (HCL). The patient presented with gradual onset of back pain and intermittent lower-extremity radicular symptoms. He did not have splenomegaly or peripheral blood count abnormalities. Admission MR imaging revealed an L-5 vertebral body lesion and a lumbar epidural lesion extending from L-3 to S-2. An [18F]fluorodeoxyglucose-PET study showed numerous sites of osseous involvement. The patient underwent minimally invasive surgical biopsy sampling of the epidural lesion. Histopathological examination revealed extranodal HCL. After treatment with a 5-day course of cladribine, the patient's symptoms resolved, and at the 16-week follow-up visit there was no radiographic or metabolic evidence of disease. Hairy cell leukemia rarely involves neurological structures, but this patient responded well to standard treatment. This case demonstrates the value of tissue biopsy procedures instead of aggressive resection and the use of minimally invasive techniques to treat an HCL spinal lesion.

Epidural abscess treated with a medial supraorbital craniotomy through an incision in the eyebrow. Case report.

The authors describe a medial supraorbital craniotomy performed through a medial eyebrow skin incision to approach an epidural abscess located in the medial anterior fossa of the skull. An 8-year-old boy presented with fevers and facial swelling. Imaging demonstrated pansinusitis and an epidural fluid collection adjacent to the frontal sinus. A medial supraorbital craniotomy was performed to access and drain the epidural abscess. The supraorbital nerve laterally and the supratrochlear nerve medially were preserved by incising the frontalis muscle vertically, parallel to the course of the nerves, and dissecting the subperiosteal plane to mobilize the nerves. This approach may be a useful access corridor for other lesions located near the medial anterior fossa.

Intraventricular hemorrhage from ruptured aneurysm: clinical characteristics, complications, and outcomes in a large, prospective, multicenter study population.

OBJECT: In this study the authors analyzed the relationship of intraventricular hemorrhage (IVH) to in-hospital complications and clinical outcome in a large population of patients with aneurysmal subarachnoid hemorrhage (SAH). METHODS: Data from 3539 patients with aneurysmal SAH were evaluated, and these data were obtained from four prospective, randomized, double-blind, placebo-controlled trials of tirilazad that had been conducted between 1991 and 1997. Clinical characteristics, in-hospital complications, and outcome at 3 months post-SAH (Glasgow Outcome Scale score) were analyzed with regard to the presence or absence of IVH. RESULTS: Patients with SAH and IVH differ in demographic and admission characteristics from those with SAH but without IVH and are more likely to suffer in-hospital complications and a worse outcome at 3 months post-SAH. CONCLUSIONS: The presence of IVH in patients with SAH has an important predictive value with regard to these aspects.

Minimally invasive lumbar spinal decompression in the elderly: outcomes of 50 patients aged 75 years and older.

OBJECTIVE: Lumbar spinal stenosis and spondylosis are major causes of morbidity among the elderly. Surgical decompression is an effective treatment, but many elderly patients are not considered as candidates for surgery based on age or comorbidities. Minimally invasive surgical techniques have recently been developed and used successfully for the treatment of lumbar spinal disease. Our objective was to examine the safety and efficacy of minimally invasive lumbar spinal surgery for elderly patients. METHODS: We reviewed demographic information, pre- and postoperative Visual Analog Scale pain scores, Oswestry Disability Index scores, and Short-Form 36 scores of prospectively accrued patients who underwent minimally invasive decompression of lumbar degenerative disease at two institutions between January 2002 and December 2005. Data from patients who were at least 75 years old were selected. Statistical analysis methods included paired t test, multiple linear regression, and linear mixed effects modeling. RESULTS: Fifty-seven patients with a mean age of 81 years met the study criteria (median follow-up period, 7 mo; mean follow-up period, 10 mo). No major complications or deaths occurred. Fifty patients had sufficient outcomes data for analysis. Visual Analog Scale pain scores decreased from 5.7 to 2.2 for back pain and from 5.7 to 2.3 for symptomatic leg pain (P < 0.05). Oswestry Disability Index scores decreased from 48 to 27; Short-Form 36 Body Pain and Physical Function scores also showed statistically significant improvements after surgery (P < 0.05). The longitudinal analysis demonstrated durability of the symptom relief. CONCLUSION: Minimally invasive lumbar spine decompression is a safe and efficacious treatment for elderly patients with spinal stenosis and spondylosis. Elderly patients should be considered good candidates for lumbar surgical decompression using minimally invasive techniques.