Lumbar and cervical spondylosis and spondylotic myelopathy.

The problem of chronic spondylitic spinal disease is markedly underrepresented in the literature. The principal focus is on procedures and diagnostic techniques. It has been suggested that the classic clinical syndromes are rare and that interventional protocols based on them are likely to be inadequate. New diagnostic techniques have revolutionized the evaluation of patients: magnetic resonance imaging is now the standard whereas myelography use is being steadily reduced. It is clear that the outcome of spinal surgery for herniated disk, in expert hands, is excellent. Nevertheless, there is an emphasis on minimally invasive and percutaneous techniques to try to avoid major surgery, which has been the standard. The natural history of these problems is still understood incompletely. Long-term follow-ups are generally not available and the value of nearly every form of conservative care remains unproven.