For a study, researchers sought to understand the viewpoints of patients and spine surgeons on surgery for adults spinal deformity decision-making. About 6 patients and 5 spine surgeons were interviewed in semistructured, in-depth interviews. To find themes, two investigators independently coded the transcripts using a continuous comparative method and an integrative, team-based approach. Patients’ themes included: patients believed surgery was their only option because they were running out of time to undergo invasive procedures; patients mentally committed to surgery before their initial consultation with their surgeon and contextualized the desired benefits while minimizing the potential risks; patients believed that current decision support tools were ineffective in preparing them for surgery, and patients believed that pain management was the most challenging aspect of surgery. Themes for surgeons: surgeons’ perceptions of shared decision-making differed widely; surgeons did not regard patients’ chronological age as a major contraindication to surgery; There was a goal mismatch between patients and surgeons in terms of desired surgical outcomes, with patients prioritizing complete pain relief and surgeons prioritizing concrete functional improvement; and surgeons believed that patient expectations for surgery were often set before their initial surgery visit, and that these expectations frequently needed to be reset. When considering surgery, older adult patients saw the decision as time-sensitive, whereas spine surgeons highlighted the need to recalibrate patient expectations and balance the risks and benefits. These outcomes underscore the need for a greater understanding of both sides of shared decision-making, which should include the needs and priorities of older persons to communicate patient-specific risks and choices effectively.