Spinal degeneration is a progressive process that starts as a minor insult to a disc or posterior joint and progresses to multilevel spondylosis. Rationalization of our treatment should permit the tailoring of the treatment to the individual patient and so improve the results. The degenerative conditions affecting the lumbar spine include disk herniation, degenerative spondylolisthesis, spinal stenosis, degenerative scoliosis, and degenerative disk disease. Most patients with these conditions are treated successfully by nonoperative means. However, a significant percentage will undergo surgical treatment that involves decompression and/or lumbar fusion. The goal of lumbar spine reconstruction in degenerative disorders is 3-fold: (1) to decompress neural compression; (2) to remove and reconstruct the affected intervertebral disc; and (3) restore instability and alignment of a pathologic motion segment. By removing the painful intervertebral disc and eliminating motion of anterior, middle, and posterior spinal structures, pain can be either reduced or eliminated from the pathologic segment.