Lumbar Spine Fusion in the Treatment of Degenerative Conditions: Current Indications and Recommendations

The role of arthrodesis in the treatment of degenerative disorders of the lumbar spine is controversial. Most patients with these conditions can be successfully treated nonoperatively. Lumbar fusion, with or without instrumentation, is associated with more complications, especially in the elderly population. Therefore, the potential benefits to be obtained by means of arthrodesis must be measured against the risks. Arthrodesis is indicated as an adjunct to decompression for patients with spinal stenosis associated with degenerative or iatrogenic spondylolisthesis and in the treatment of progressive degenerative lumbar scoliosis and iatrogenic instability resulting from extensive decompression. The occurrence of two or more episodes of disk herniation at the same segment is a relative indication for arthrodesis. In patients with incapacitating nonradicular back pain, arthrodesis should be a consideration only after failure of a trial of nonoperative treatment lasting more than 12 months and after secondary gain issues (e.g., workmen's compensation) have been adequately resolved. Arthrodesis has a poor success rate when used to treat back pain associated with multilevel disk degeneration seen on magnetic resonance images.