Surgery for intervertebral disk disease of the lumbar spine.

There is little doubt that surgical treatment of lumbar spine pain is often unsatisfactory. It is likely that we are using a cannon when a peashooter properly aimed would do a better job. Various injection techniques, especially injection of the disk itself would seem to be a rational approach. Scarring around the spinal nerves and dura is an unsolved problem. The search for an interposition membrane goes on. Fat grafts are being advocated, but it is too early to evaluate their efficacy. The problem of how to adequately decompress the nerves in spinal stenosis without jeopardizing spinal stability is still unsolved. Interbody fusion still carries a high failure rate as far as fusion is concerned, but what is worse, failure to relieve the pain for which it was done remains frequent. Spine pain programs concentrating upon training in exercises, training in the proper way to perform the activities of daily living and especially psychological counseling and operant conditioning probably represent the greatest single recent advance in the rehabilitation of the low back sufferer. Finally, there is an unfulfilled need for more accurate reporting of our subjective clinical results if advances are to be made in this area, where pain is the principal problem.