The Pennsylvania Plan II: an algorithm for the management of lumbar degenerative disc disease.

We have thus presented a series of decision-making processes that are easy to follow, clearly defined, and cost effective. We have found that with the use of this decision-making algorithm our patients receive the therapeutic measures most helpful at the optimal time and are neither denied helpful surgery nor submitted to operations that are useless surgical exercises. With the use of this protocol, we believe that our efficiency as surgeons, physicians, and advisors will increase and the specter of fear found in the general population regarding low back pain will diminish.