title: Guideline update for the performance of fusion procedures for degenerative disease of the lumbar spine. Part 5: correlation between radiographic outcome and function.
abstract: In an effort to diminish pain or progressive instability, due to either the pathological process or as a result of surgical decompression, one of the primary goals of a fusion procedure is to achieve a solid arthrodesis. Assuming that pain and disability result from lost mechanical integrity of the spine, the objective of a fusion across an unstable segment is to eliminate pathological motion and improve clinical outcome. However, conclusive evidence of this correlation, between successful fusion and clinical outcome, remains elusive, and thus the necessity of documenting successful arthrodesis through radiographic analysis remains debatable. Although a definitive cause and effect relationship has not been demonstrated, there is moderate evidence that demonstrates a positive association between radiographic presence of fusion and improved clinical outcome. Due to this growing body of literature, it is recommended that strategies intended to enhance the potential for radiographic fusion are considered when performing a lumbar arthrodesis for degenerative spine disease.
authors: Department of Neurological Surgery, University of California, San Francisco, California;
authors: Sanjay S
authors: SS
authors: Dhall
authors: Tanvir F
authors: TF
authors: Choudhri
authors: Jason C
authors: JC
authors: Eck
authors: Michael W
authors: MW
authors: Groff
authors: Zoher
authors: Z
authors: Ghogawala
authors: William C
authors: WC
authors: Watters
authors: Andrew T
authors: AT
authors: Dailey
authors: Daniel K
authors: DK
authors: Resnick
authors: Alok
authors: A
authors: Sharan
authors: Praveen V
authors: PV
authors: Mummaneni
authors: Jeffrey C
authors: JC
authors: Wang
authors: Michael G
authors: MG
authors: Kaiser
mesh_terms: D004185:Disability Evaluation; D019317:Evidence-Based Medicine; D006801:Humans; D008159:Lumbar Vertebrae / Q000000981:diagnostic imaging* / Q000473:pathology / Q000601:surgery*; D059408:Pain Management; D011183:Postoperative Complications / Q000000981:diagnostic imaging* / Q000473:pathology; D017410:Practice Guidelines as Topic; D011859:Radiography; D020127:Recovery of Function; D013122:Spinal Diseases / Q000473:pathology* / Q000601:surgery*; D013123:Spinal Fusion / Q000592:standards*
keywords: ALIF = anterior lumbar interbody fusion; DPQ = Dallas Pain Questionnaire; LBOS = Low Back Outcome Scale; LBPR = Low Back Pain Rating Scale; PLF = posterolateral lumbar fusion; VAS = visual analog scale; fusion; lumbar spine; practice guidelines; treatment outcomes