SHOULD FUSION ACCOMPANY LUMBAR DISKECTOMY - A MEDIUM-TERM ANSWER

The results of lumbar diskectomy for a sciatic syndrome in 90 patients were reviewed at an average of 8.5 years after operation. The best re sults were achieved in those patients who had their diskectomy within 12 months of the onset of their symptoms and through minimal approache s. Eighty-six percent of patients returned to gainful employment. Sixt een patients (18%) returned with low back pain attributable to the los s of intervertebral disk, of whom eight (9%) required secondary spinal fusion for control of pain. Seven of these latter patients obtained g ratifying clinical and functional results. The findings suggest there is insufficient indication for routine spinal arthrodesis combined wit h lumbar disk excision. Those eight patients (9%) who developed a disa bling postdiskectomy/ postlaminectomy instability syndrome did so usua lly as a consequence of excessive bone and ligament excision and benef itted significantly from subsequent spinal arthrodesis.