Spinal surgery is one of the most frequently performed surgeries in the United States. In 2003, almost 450,000 cases were performed for problems related to lumbar herniated disks, stenosis, and degenerative changes. It has been reported that patient expectations play a role in perceived quality of life (QOL). Because surgery is frequently a last resort for patients with spinal disease, patients often have high expectations of their outcomes of surgery. Patient expectations of surgical outcome may play an important role in recovery and perceived QOL. The research on patient expectations of surgery in the spinal surgery literature is limited. This study examined the relationships between perceived QOL, expectations, and level of optimism. A sample of 57 patients completed questionnaires designed to measure perceived QOL, expectations, and optimism before lumbar spinal surgery and 3 months after surgery. The major findings of the study are as follows: (a) patients with higher degrees of optimism reported better perceived QOL; (b) increased fulfillment of expectations was associated with better postoperative QOL; and (c) both expectations and level of optimism were significant predictors of postoperative QOL. These findings will help nurses better understand how patients' expectations can affect their perceived QOL while recovering from lumbar spinal surgery.