Drawing of vertebral bodies in degenerative disk disease Fig.
Patients experience symptoms associated with compression of the nerve roots and cauda equina.
Back pain is usually the primary complaint making it important to differentiate the pain from that caused by musculo-ligamentous strain. It is for this reason that we stress the importance of extensive conservative therapy before considering surgical intervention. A positive diskogram, where injection of radiopaque dye into the affected disk reproduces the patients pain and outlines a fissured or ruptured disk, localizes the level of involvement. While compression may be caused in part by herniation of the disk, diskectomy alone is not effective in providing relief since additional impingement is produced by the reduction in disk space height and abnormal amount of movement allowed by the joint. Typically, PLIF with cages is only performed on patients with 6 months of intolerable pain in whom all forms of conservative treatment have failed.