The Pennsylvania Plan. An algorithm for the management of lumbar degenerative disc disease.

An algorithm for the sequential management of the patient with low-back pain has been formulated from evaluation of treatment outcomes. Patients presenting with back pain complaints and cauda equina syndrome are evaluated with immediate myelography. Without this complication, back pain patients are treated with 6 weeks of conservative therapy. Those who fail to respond are evaluated with progressively more complex techniques. When sciatica predominates, treatment may ultimately include laminectomy. When back pain predominates, medical and psychosocial appraisal are recommended. Some with normal medical and psychosocial evaluations may become candidates for spine fusion. The remaining are treated according to the findings of such appraisals. Rigorous screening is mandatory prior to any surgery.