The Lumbar Spine An Orthopaedic Challenge.NACHEMSON, ALF L. MDSpine: March 1976 Original Article: PDF Only Abstract The low-back pain problem reviewed in this paper represents a great challenge to orthopaedic surgeons around the world. Although in most instances a rather undramatic problem, low-back pain is, in patients aged 30 to 60 years, the most expensive ailment from a socio-economic viewpoint. The intervertebral disc is most likely the cause of the pain, but at present the etiology is unknown, and hence, for the majority of patients, only symptomatic treatment is available. So far no convincing evidence exists that any type of conservative treatment for the patient with low-back pain is superior to nature's own course. The paramount importance of a correct preoperative diagnosis for those with sciatica due to disc herniation is reiterated. For 98% of patients, the present knowledge of the psychologic, social, and mechanical stress factors, which are described in this paper, should be utilized for proper counseling, together with attempts at correction with any type of noninvasive modality according to the preference of the individual physician. (C) Lippincott-Raven Publishers.