Decompression, arthrodesis, and arthroplasty: decision making in the surgical treatment of lumbar disc disease.

What was once a simple lumbar disc herniation treated with laminotomy and partial discectomy, with typically excellent results (25, 46), has evolved into a surprisingly complex clinical problem with a dazzling array of therapeutic alternatives. Much of this, of course, is based on clinical studies emphasizing the heterogeneity of disc disorders. Advances in biomechanics research focusing on the lumbar disc have provided valuable insights into the consequences of disc herniation and progressive degeneration in the lumbar spine complex. But in the end, what has this work meant to our patients?