WHEN IS SPINAL-FUSION WARRANTED IN DEGENERATIVE LUMBAR SPINAL STENOSIS

This study, conducted by a group of neurosurgeons who devote a large p ortion of their professional time to the treatment of degenerative lum bar spine lesions, was prompted by the dramatic increase in the number of lumbar spinal fusion procedures performed over the last few years in a broad spectrum of disorders ranging from chronic incapacitating l ow back pain to lumbar spinal stenosis. In the authors' experience, lu mbar spinal fusion is rarely warranted and often of dubious efficacy T o investigate this contradiction, the authors reviewed the medical lit erature on lumbar spinal fusion for the treatment of degenerative spin al stenosis. They have defined lumbar instability as objectively as po ssible, reviewed clinical and roentgenographic features, described spi nal fusion techniques with the drawbacks of each, and evaluated outcom es of surgery for degenerative lumbar spinal stenosis with or without fusion. Findings demonstrate that spinal fusion is a technique of unpr oven benefit that should be used only in carefully selected patients u ntil results of reliable, prospective, comparative clinical trials bec ome available. In the authors' opinion lumbar spinal fusion should be used as the first-line treatment only in young patients with clinical manifestations directly related to lumbar instability as defined in th is study, when decompression requires removal of both facet joints and of the disk (which is rarely the case) or when simple decompression i s followed by a recurrence of symptoms ascribable to worsening vertebr al slippage.