Surgical treatment of internal disc disruption: an outcome study of four fusion techniques

Surgical treatment for internal disc disruption remains controversial in terms of efficacy of spinal fusion and optimal fusion method. The present study was carried out in 56 consecutive patients, with the diagnosis confirmed by computed tomographic (CT) discography, who were operated with one of four different lumbar fusion procedures. Outcomes were determined by postoperative pain questionnaires, independent clinical assessment, and radiographic evaluation. Simultaneous anterior interbody fusion using BAK cage and posterior facet fusion provided the highest rate of fusion (88%) and clinical satisfaction (63%). Pain scores were also significantly lower than facet screw augmented posterolateral fusion, and anterior interbody fusion with fibula allograft, but not significantly different from pedicle screw instrumented posterolateral fusion. Patients who achieved successful lumbar fusion had better clinical outcomes and a better chance of work resumption.