Contributions to a rational diagnosis and treatment of lumbar disk

There is a possibility that some of the above mentioned statements that seem contradictory at first glance will perhaps hold true in peaceful co-existence at second glance. Yet it will be undeniable that some confusion will be part of the researcher or clinician, interested patient, health care planner,9 medical auditor2 or journal editor, 15 who wants to know what is the prevailing professional view and the state of the art of the diagnosis and therapy of this disease. All of these - except for the researcher- do not have enough time, funds and energy to spend several years in collecting and analysing data for their question and fill in possible white areas in our map of knowledge. Most likely they will take refuge in reviewing existing data from the literature, and will try to sift and sort the differently qualified evidence and to combine equivalent data and weigh it against opposite facts. Well, this (and nothing more) is the purpose of the present thesis. Be it that an attempt has been made towards a rational and rationalising way of analysis and synthesis of the research question. This approach, in the past decades borrowed from the military and the econometric and the psychometric domains, can be applied to medical problems as well and is then called "medical decision analysis" (in Dutch medische besliskunde ). The result is not an accurate description of all aspects of diagnosis and treatment ofLDH, but rather a crude representation of the major choices that have to be made in the course of "managing a patient" with this disease. Advocates of this method, emphasizing that decision makers cannot wait and have to adhere to existing data sources, claim that the re~uired data usually can be found in the literature. This claim has waned, however. Another movement, that of meta-analysis6 is indeed exploiting the literature, but indicates that the gold is buried very deep.

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