SPINAL INSTRUMENTATION IN THE MANAGEMENT OF DEGENERATIVE DISORDERS OFTHE LUMBAR SPINE

The use of spinal instrumentation as an adjunct to fusion for the trea tment of degenerative disorders of the lumbar spine is controversial, Instrumented lumbar fusions, in specific instances, may improve patien t outcomes, For patients undergoing single level primary lumbar arthro desis, the available data do not conclusively support the efficacy of spinal instrumentation, However, in the setting of previous failed lum bar surgery, iatrogenic or degenerative lumbar spondylolisthesis, spin al instrumentation may be useful as an adjunct to fusion, Possible adv antages associated with the use of instrumentation include: correction of deformity in frontal and sagittal planes; decreased pseudarthrosis rates; prevention of progression of spondylolisthesis, and provision of spinal stability in the absence of intact posterior elements, Compl ications associated with the use of instrumentation include: increased cost; increased operative times; increased infection rate; increased reoperation rate; and a steep learning curve, Therefore, when instrume ntation is to be used, the benefits must outweigh the risks, These ris ks can be minimized by the judicious use of instrumentation by experie nced surgeons, for specific indications as supported by the literature .