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Nonsurgical treatments
Physical therapy and analgesics are the most common therapy for spinal problems. Maintaining spinal strength and flexibility through exercise is important. Passive manipulation may have a role, but it's not a substitute for strengthening the muscles.
 
Nerve pain, such as sciatica, usually does not respond well to physical therapy and is therefore often treated by an epidural. This is an image guided spinal procedure performed as a day-case using fine needles and probes, which are inserted through the skin and guided by continuous X-Ray or CT screening directly to the site of the suspected problem. 
 
Surgical treatments
Surgical therapy is typically recommended when symptoms have not improved using other treatments and the patient has difficulty standing or walking and there is progressive muscle weakness or altered bladder function. 

Changing Spine surgery
Over the next 20 years, as populations' age, spine surgeons will be challenged to address a different mix of diagnoses and additional comorbidities; such as lumbar spinal stenosis and spondylolisthesis.
 
Nearly 25% of people over 65 suffer low back pain.  In the US alone this translates into over seven million doctor visits annually.  Over the next decade, degenerative spinal conditions are projected to significantly increase pressure on hospitals and primary care offices.  
 
More of these older patients however, are expected to have access to advanced spine care and minimally invasive techniques.  According to Mr. Malik, "Research is driving advances in surgical techniques as well as new devices and tools, which will expand the treatment options for patients."
 
Takeaways
Health providers are beginning to look for new ways to combat the combined challenges of aging populations, shifting comorbidities and projected shortages of doctors. Training is encouraged in surgical specialities where there are shortages and nurses are being trained to conduct initial patient visits.

Increasingly, patients are given e-mail access to clinics to determine treatments, computer portals are being used to streamline the entry process to clinics and video explanations of surgical procedures and teir risks are being developed specifically for patients.