For the last 3 years, after 31 years in private practice, I have had the great pleasure of being a member of an academic neurosurgery program. The Carilion Neurosurgery Department has afforded me the opportunity to focus on degenerative spine surgery, which is, and has been for some time, the area of my primary interest. I had no idea that working with diligent, stimulating, and enthusiastic residents could be so enjoyable. But I have also learned that their considerable responsibilities in a busy general neurosurgical practice, at a Level I trauma center, affords them little time (either in the clinic or the OR) to develop the fundamental clinical and technical skills necessary for the care of patients with degenerative spine pain. The learning curve in the care of the painful degenerative lumbar spine is a long one. This is partly because the pathology in any given patient has a singular character. The anatomy of that pathology always varies in some degree, so that it will not be precisely alike any other. Furthermore, the multi-variant clinical factors in any patient can never be the exact same as in any other patient. The experienced surgeon therefore should have significant instructive value, clinically and operatively, to the young surgeon willing to learn what is still, to a large degree, an art. This book is not primarily meant to be a technical treatise. For instance, it is not so concerned with the specifics of the technique in the various types of lumbar fusion. It is more concerned, however, with identifying the patient who needs a fusion, and why a particular fusion method for that individual patient is the best option. And yet as degenerative lumbar spine surgery mainly concerns itself with various techniques of neural decompression, the principles of these methods will be presented, some of which may not be generally understood and practiced.