Treatment of Degenerative Lumbar Spine Disease When Lumbar Back Pain Is the Main Symptom
This protocol applies when lumbar back pain is the dominant presenting complaint in a patient with degenerative lumbar spine disease, and the responsible structural pathology — segmental instability, osteochondrosis, or degenerative spondylolisthesis — is clearly identified and confirmed on imaging.
Clinical Scenario
The patient presents with lumbar back pain as the main symptom, arising on the basis of one or more of the following:
- Segmental instability of the lumbar spine
- Osteochondrosis of the lumbar spine
- Degenerative spondylolisthesis of the lumbar spine
A key prerequisite for this protocol: the morphological changes seen on imaging must clearly account for the patient's symptoms and clinical findings.
Treatment Approach
The structured protocol for this presentation centres on spinal fusion surgery combined with decompression. The operative approach is selected on the basis of the individual patient's symptoms and imaging findings — the full algorithm, including technique selection and procedural detail, is available in the complete protocol.
Clinical Goals
- Improvement in lumbar back pain
- Improvement in leg pain
- Improvement in quality of life
References
DOI: 10.3238/arztebl.m2025.0056
- Is the main symptom back pain on the basis of segmental instability, osteochondrosis, or spondylolisthesis?
- The degenerative changes that are seen on imaging studies and that are to be operated on must clearly be responsible for the patient's symptoms and signs.
- Fusion surgery with decompression depending on the symptoms and imaging findings.
- Among these techniques, PLIF and TLIF have been most widely used and studied.
- When performed for strict indications, fusion surgery brings about significant long-term improvement.
- Significant improvement of back pain, leg pain, and quality of life in both groups.
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