Degenerative disc and vertebral disease – clinical

Low back pain, disc prolapse and spinal stenosis are the three principal clinical problems in the lumbar spine. Prompt clinical triage in low back pain will allow early active management, with improved results. The specificity and sensitivity of the ‘red flags’ has been described, and in conjunction with formal review of patients allows sufficient clinical confidence. Recent National Institute for Health and Clinical Excellence guidelines have provided significant advances in back pain management. Spinal fusion for low back pain has a role in precisely defined circumstances. New research into intervertebral disc prolapse has also clarified the place of early surgery in providing more rapid improvements in pain and disability, with a significant reduction in the ‘area under the curve’. New surgical approaches to spinal stenosis have reduced morbidity and clarified the role of fusion in decompression operations.