Degenerative disorders of the lumbar and cervical spine

The etiology of symptom manifestation in lumbar and cervical spine degeneration is multifactorial and includes cellular, biochemical, and biomechanical causes. Accurate identification of pain generators in the degenerative spine can be challenging. After a diagnosis is made, however, treatment measures must address the patient's pain, neurologic function, and spinal stability. The clinician must understand that degenerative disorders in the spine are normal, age-related phenomena and largely asymptomatic in most cases. Conservative management of lumbar and cervical spondylosis is the mainstay of treatment, and most patients with symptomatic degenerative changes respond appropriately with nonsurgical management. Only when conservative measures have failed can surgical intervention be considered an appropriate and viable option. Treatment options should always be directed toward the specific nature and location of the patient's individual pathology. Although current standards in the surgical management of lumbar and cervical degenerative disorders include discectomy, neural decompression, and instrumented spinal arthrodesis, new approaches that address this often-challenging clinical entity are on the horizon.