title: Guidelines for the performance of fusion procedures for degenerative disease of the lumbar spine. Part 8: lumbar fusion for disc herniation and radiculopathy.
abstract: There is no convincing medical evidence to support the routine use of lumbar fusion at the time of a primary lumbar disc excision. There is conflicting Class III medical evidence regarding the potential benefit of the addition of fusion in this circumstance. Therefore, the definite increase in cost and complications associated with the use of fusion are not justified. Patients with preoperative lumbar instability may benefit from fusion at the time of lumbar discectomy; however, the incidence of such instability appears to be very low (< 5%) in the general lumbar disc herniation population. Patients who suffer from chronic low-back pain, or are heavy laborers or athletes with axial low-back pain, in addition to radicular symptoms may also be candidates for fusion at the time of lumbar disc excision. Patients with a recurrent disc herniation have been treated successfully with both reoperative discectomy and reoperative discectomy combined with fusion. In patients with a recurrent lumbar disc herniation with associated spinal deformity, instability, or associated chronic low-back pain, consideration of fusion in addition to reoperative discectomy is recommended.
authors: Department of Neurosurgery, University of Wisconsin Medical School, Madison, Wisconsin 53792, USA. Resnick@neurosurg.wisc.edu
authors: Daniel K
authors: DK
authors: Resnick
authors: Tanvir F
authors: TF
authors: Choudhri
authors: Andrew T
authors: AT
authors: Dailey
authors: Michael W
authors: MW
authors: Groff
authors: Larry
authors: L
authors: Khoo
authors: Paul G
authors: PG
authors: Matz
authors: Praveen
authors: P
authors: Mummaneni
authors: William C
authors: WC
authors: Watters
authors: Jeffrey
authors: J
authors: Wang
authors: Beverly C
authors: BC
authors: Walters
authors: Mark N
authors: MN
authors: Hadley
mesh_terms: D006801:Humans; D007405:Intervertebral Disc Displacement / Q000601:surgery*; D008159:Lumbar Vertebrae / Q000601:surgery*; D011843:Radiculopathy / Q000601:surgery*; D013122:Spinal Diseases / Q000601:surgery*; D013123:Spinal Fusion / Q000592:standards*