Vertebral pain syndromes due to osteochondrosis are one of the most prevalent human diseases. In the article contemporary approaches to surgical treatment of this pathology are presented. To treat successfully a correct selection of patients for surgical intervention and a choice of an adequate surgical techniques (puncture, endoscopic, microneurosurgical methods) are necessary. The key issues for surgical treatment in discogenic myeloradicular syndromes are: 1) adequacy of diagnosis; 2) determination of suitableness for the surgical intervention; 3) choice of a surgical access and method; 4) objectivation of efficacy of the intervention. In the article a detailed explanation for each key issue is given, and direct and distant results of the treatment in 1400 patients have been analyzed.