The principle considerations and recommendations for assessment and treatment of low back pain patients are as follows:

Patients must have an initial assessment to rule out serious systemic or local disease. This will include a medical history and physical examination. One of the greatest challenges for the physician is making an accurate diagnosis which will dictate the optimal treatment.

Physicians should institute effective initial management to reduce the rate of recurrence and chronicity. If the symptoms have not resolved in the first four weeks with medications and activity modification, VAX-D should be considered for those patients with disc related pain.

In general, discogenic conditions will include annular tears, disc protrusion, herniation and extrusion, sequestration, Internal Disc Disruption (IDD) and degenerative disc disease. The disc can affect the lateral nerve roots causing other symptoms such as pain, numbness and motor loss in the leg and foot.

Only patients with progressive neurological deficit, cauda equina syndrome, or spinal instability are considered early surgical candidates.

Research clearly indicates that in the absence of the above conditions, surgical patients have the same long-term outcomes as those who receive effective non-surgical care.