The role of surgery in nerve root compression.

If nonoperative treatment fails to relieve the symptoms of nerve compression in a 6-8 week period, surgical decompression may be indicated. Prior to embarking on such a course the surgeon must have a precise neurologic diagnosis. This diagnosis must be clinical, with corroborating radiographic, electrodiagnostic and nerve block evidence. The important concept is: think nerve root. Surgical management must be tailored to the individual, depending on that individual's local anatomy and local pathology, be it disc or lateral bony entrapment. The surgeon should not have preconceived ideas about the cause of nerve compression and should be guided by the findings at operation. To prevent intractable back pain following nerve decompression, those patients with spondylolisthesis or segmental instability should be considered candidates for a spinal fusion.