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Is fusion indicated for lumbar spinal disorders?
1Division of Neurological Surgery, Barrow Neurological Institute, Phoenix, Arizona, USA.
Spine
|December 15, 1995
Summary
Lumbar spinal fusion is indicated for instability, but instrumentation improves outcomes. Definitive indications include trauma, tumor, infection, and spondylolisthesis; relative indications involve degenerative conditions and mechanical pain.
Area of Science:
- Neurosurgery
- Orthopedic Surgery
- Spinal Disorders
Background:
- Lumbar spinal fusion is frequently performed, yet clear indications remain undefined.
- A review of literature and clinical experience is necessary to clarify these indications.
Purpose of the Study:
- To discuss the indications for lumbar spinal fusions.
- To establish definitive and relative indications for spinal arthrodesis in various lumbar spine disorders.
Main Methods:
- Comprehensive literature review and critical examination of clinical experience with lumbar spinal instability.
- Assessment of the role of fusion (with or without instrumentation) versus decompression alone.
Main Results:
- Spinal fusion is indicated once lumbar spinal instability is diagnosed.
- Fusion without instrumentation has a high pseudarthrosis rate and poorer patient outcomes.
- Spinal instrumentation should be used as an adjunct to spinal arthrodesis.
Conclusions:
- Definitive indications for lumbar fusion: trauma, tumor, infection, iatrogenic instability, ischemic spondylolisthesis.
- Relative indications: degenerative spondylolisthesis, abnormal motion with pain/neurologic deficit, mechanical pain.
- Lumbar fusion is rarely indicated for routine discectomy, radiographic abnormalities without clinical findings, or stable spinal stenosis.