The benefit of surgical treatment for some diseases affecting the lumbar spine is not controversial in many clinical circumstances, such as major trauma with gross instability, unstable spondylolisthesis, persistent or complicated spinal infections, and some spinal tumors with progressive neurologic loss. More commonly a patient may contemplate surgical treatment for complications of common degenerative conditions affecting the lumbar disk. In general, 2 clinical syndromes are associated with these degenerative conditions, and the clinical course and efficacy of interventions for each is very different. The first is primary back pain with little or no component of radicular symptoms due to nerve root irritation. The second is primary radicular pain, which usually has some component of back pain.
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