Abstract

Symptom-focused care of the painful degenerative lumbar spine defines a clinical philosophy whereby the surgeon, by intensive interaction with the patient, establishes precisely the patient’s primary complaint. With rare exception, such complaint is described as some form of pain. The surgeon must then determine the etiology of the presenting pain complaint and thus establish, at least tentatively, a diagnosis. It is necessary for the surgeon to have the expertise to identify non-surgical and/or non-spinal etiologies, and it is incumbent on him/her, as physicians first and surgeons second, to address some therapeutic approach for non-surgical pathologies.

SFC surgery for the PDLS is primarily focused on relief of the presenting pain, requiring, in most instances, some form of root decompression. The decision for surgery is primarily a clinical one and is individualized, respective of the innumerable pertinent factors variable from patient to patient. Image evaluation, usually MRI, is used to confirm radicular compression at the site congruent with that determined by clinical evaluation.

In SFC surgery of the PDLS, fusion/instrumentation is mainly done adjunctively as a prophylactic measure, avoiding the potential for increasing instability. Image-defined spinal deformity, therefore, is not a primary imperative and its correction is relevant only to adequate root decompression. This absence of any compulsion for deformity correction is, relatively, surgery-limiting and can be considered a minimalism surgery. This clinical minimalistic approach is differentiated from mini-invasive surgery (MIS) which is a technical term. Minimalism surgery defines “what” surgery is to be done; MIS describes methodologically “how” the surgeon may accomplish it.