Nerve roots and spinal nerves in degenerative disk disease.

After 43 years of investigating the intervertebral disk, the long term results of the management of patients from the standpoint of pain are not significantly different than they were prior to the identification of the herniated disk nor do they seem to be significantly different than no treatment at all. This should at least suggest that the phenomena of low back pain is far more complex than can be accounted for on the basis of a simple mechanical-pressure theory of disk derangement. There is a significant volume of literature that would point to the neural tissues themselves as the most logical structures for future research that attempts to interfere with the natural history of this disease from the standpoint of pain. It seems most appropriate to attack lumbar disk disease from this standpoint because except in uncommon cases, the pathological process is benign and self limiting. It also seems logical that major advancements in the management of "diskogenic" back pain will depend upon an appreciation of the importance of controlling neural inflammation in the early phases of the disease rather than developing new techniques of managing irreversible neural lesions and their iatrogenetic or psychiatric sequelae.