The diagnosis and treatment of painful degenerative disc disease remains one of the most controversial topics in the spine literature. The debate continues as to whether surgical treatment should be attempted, and if so, which surgical approach is optimal. Surgical options include the following general types of spinal fusions: posterolateral (instrumented or noninstrumented), anterior lumbar interbody, posterior lumbar interbody, and transarticular facet joint screws. Dr. Nachemson continues to take his long‐standing position that the diagnosis is unreliable and that the outcomes are inadequate to justify the risks and costs. Dr. Zdeblick believes that instrumented posterolateral spinal fusions can offer a high degree of success with an acceptably low rate of complications. Finally, Dr. O'Brien believes that the pain generator is anterior and that the treatment should be anterior discectomy and interbody fusion combined with posterior transarticular facet screw fusion.