Pathophysiology and rationale for treatment in lumbar spondylosis and instability.

The author discuss the pathophysiology and the rationale for treatment of low back pain in spondylosis and instability. The concept of the three phases of degeneration is useful in understanding [correction of the comprensione] the clinic-pathological correlations. Surgical indications for low back pain and sciatic are rare, because of the natural history of degenerative instability and spinal stenosis is usually benign. Surgical treatment, decompression and/or fusion, is indicated when conservative treatment fails. Decompression is indicated, in addition to disc herniation, for central and lateral stenosis. Fusion is indicated for lytic and degenerative spondylolisthesis, after facetectomy, in some cases of scoliosis. Simple degenerative disc disease, in the absence of herniation, nerve compression or instability, is not an indication for surgery. There is no proof yet that fusion for back pain alone, due to degenerative disc disease, is better than the natural history of the disease.