Patient Outcomes After Lumbar Spinal Fusions

Abstract

For several low back disorders no advantage has been demonstrated for fusion over surgery without fusion, and complications of fusions are common. Randomized controlled trials are needed to compare fusion, surgery without fusion, and nonsurgical treatments in rigorously defined patient groups.

Decision Making in Surgical Treatment of Chronic Low Back Pain: The performance of prognostic tests to select patients for lumbar spinal fusion

“…if in these patients equivocal results exist after routine diagnostic tests, great caution with regard to lumbar fusion is warranted. these findings are in accordance with other reports, stating that there are no reliable tests for preoperative selection of failed back surgery patients and that, consequently, the results of lumbar fusion are discouraging (Lehmann et al 1987;turner et al 1992;Wetzel et al 1994). although we realise that pain is merely one of the many factors related to the problem "chronic low back pain", the criterion of pain reduction on a Visual analogue scale was chosen to assess successful outcome.…”

“…spinal fusion was first described in 1891 for stabilisation of vertebral segments in spinal tuberculosis (hadra 1891) and has a well-established role in the treatment of spinal fractures and deformities. its role in the treatment of cLbp, however, remains controversial (turner et al 1992;Krismer 2002). epidemiological research reveals large variation in the amount of spinal fusion operations between countries (cherkin et al 1994) and even between different regions within the same country up to 20-fold ranges in fusion rate have been reported (Katz 1995;Weinstein et al 2006).…”

Increasing age does not affect good outcome after lumbar disc replacement

“…Lumbar arthrodesis (fusion) assisted by bone graft and/or instrumentation is a widely practiced method to treat segmental instability, but has many potential complications [8,11]: pseudo-arthrosis rates of up to 44% [10], significant co-morbidity related to both instrumentation and graft donor site, the need for additional external support and prolonged costly rehabilitation. Accelerated degeneration of adjacent motion segments after fusion -particularly multilevel procedures is causing concern amongst clinicians [6].…”

Posterior dynamic stabilization of the lumbar spine with the Accuflex rod system as a stand-alone device: experience in 20 patients with 2-year follow-up

“…Stability of the motion segment after decompression is a major clinical concern, fusion is considered to be the treatment of choice, however, and average 68% of patients have shown positive results with it [24]. Additionally, adjacent segment degeneration, pseudarthrosis, spinal canal stenosis, and donor-site morbidity associated with the harvesting of autologous bone grafts have been described [11,22].…”