DEGENERATIVE DISEASE OF THE ADULT LUMBER SPINE A Methodological Approach to the Diagnosis and Surgical Treatment of Back Pain Back pain and sciatica secondary to degenerative disc

Back pain and sciatica secondary to degenerative disc disease of the adult lumber spine are incredibly common medical complaints heard repeatedly by physicians. In spite of this mundane complaint most physicians, including both neurosurgeons and orthopaedic surgeons, continue to be perplexed by this entity, which exasperatingly remains fraught with confusion, controversy, and obfuscating terminology. Even its basic cause remains a mystery to most. The public is perplexed and frustrated by an expensive and seemingly haphazard series of oftentimes trendy and ineffective treatments. New ideas and concepts continually embellished by technology and jargon persistently rise up succeeding to further mystify and surround this ubiquitous medical entity. A quick demonstration of this latter point is made when one considers the relatively recent reintroduction of posterior spinal fusion and anterior spinal fusion techniques supplemented by a maddening and expensive array of hardware; the ubiquitous, confusing, and inappropriate use of MRI; and the never-ending rush to develop an expanding and diverse assortment of minimally invasive surgical techniques. Amidst all of this the very source of back pain remains controversial and not universally defined. The terminology and nomenclature used to describe back pain and the various medical syndromes associated with degenerative disc disease are imprecise, misleading, and often inaccurately applied. Inaccurately ascribing the clinical situation to muscle pulls, muscle cramps, low potassium, arthritis, fibromyalgia, dysfunctional psychic states, etc. illustrates this point. Frequently the clinical problem is inappropriately ascribed to muscle pulls, muscle cramps, low potassium, arthritis, fibromyalgia, and a variety of other maladies. The list is endless. Lacking universal definition and precise nomenclature one is led further a field as the confusion and frustration are heightened.