Indications for Surgical Fusion of the Cervical and Lumbar Motion Segment

Abstract

Lumbar and cervical fusion in the degenerative spine is frequently performed. Certain criteria have been established when a fusion should be considered. However, even these are not universally accepted. Strict prospective studies are needed to determine when a fusion of the degenerative, cervical, and lumbar spine is indicated. Patients with severe radicular pain may be considered for surgery after a comprehensive trial of conservative management. Fusion is usually necessary after a cervical discectomy, especially when spondylosis or osteophytic compression is present. Lumbar fusion is rarely indicated for routine discectomy. In patients with mechanical back or neck pain, surgery should only be considered after conservative measures have been exhausted and a radiographic abnormality is present at the symptomatic level, perhaps with pain concordant with discographic findings. Careful patient selection is the key to obtaining favorable surgical outcomes. In many cases, the goal may be a return to functionality rather than achieving a completely asymptomatic state.

Spinal Instrumentation in Patients with Primary Spinal Infections Does Not Lead to Greater Recurrent Infection Rates: An Analysis of 118 Cases

“…In the setting of an infection, spinal instability has been defined as vertebral height reduction of !50%, spinal angulation exceeding 20%, sagittal displacement of a vertebra greater than 3 mm, or relative sagittal plane angulation greater than 11 degrees (2,5,10). Instability after laminar decompression has been observed in patients with pre-existing loss of lordosis or in patients undergoing multisegment decompression or !30% resection of a facet joint (35).…”

Efficacy of surgery and type of fusion in patients with degenerative lumbar spinal stenosis

“…Of these, stenosis was associated with grade I degenerative spondylolisthesis at L4-5 in seven patients, with degenerative lumbar scoliosis less than 20°in five patients, and with dynamic instability in 26 patients. 3 Patients who had back pain only were excluded. Surgical interventions were recommended to patients who had persistent symptoms that were refractory to at least 6 months of conservative treatment.…”

Treatment of degenerative spondylolisthesis: potential impact of dynamic stabilization based on imaging analysis

“…The dynamic device studies to date have allowed only Grade I slip for interspinous and PSB systems (Table 1). Evidence to date indicates that Grade II or larger slips requiring decompression should be fused [1].…”

“…Translation of greater than 3 mm or 5-10°of rotational movement on lateral flexion-extension radiographs is radiographic evidence of instability [1]. In the past, this definition of instability has been an absolute indication for fusion [5].…”