title: Guideline update for the performance of fusion procedures for degenerative disease of the lumbar spine. Part 7: lumbar fusion for intractable low-back pain without stenosis or spondylolisthesis.
abstract: Establishing an appropriate treatment strategy for patients presenting with low-back pain, in the absence of stenosis or spondylolisthesis, remains a controversial subject. Inherent to this situation is often an inability to adequately identify the source of low-back pain to justify various treatment recommendations, such as lumbar fusion. The current evidence does not identify a single best treatment alternative for these patients. Based on a number of prospective, randomized trials, comparable outcomes, for patients presenting with 1- or 2-level degenerative disc disease, have been demonstrated following either lumbar fusion or a comprehensive rehabilitation program with a cognitive element. Limited access to such comprehensive rehabilitative programs may prove problematic when pursuing this alternative. For patients whose pain is refractory to conservative care, lumbar fusion is recommended. Limitations of these studies preclude the ability to present the most robust recommendation in support of lumbar fusion. A number of lesser-quality studies, primarily case series, also support the use of lumbar fusion in this patient population.
authors: Center for Sports Medicine and Orthopaedics, Chattanooga, Tennessee;
authors: Jason C
authors: JC
authors: Eck
authors: Alok
authors: A
authors: Sharan
authors: Zoher
authors: Z
authors: Ghogawala
authors: Daniel K
authors: DK
authors: Resnick
authors: William C
authors: WC
authors: Watters
authors: Praveen V
authors: PV
authors: Mummaneni
authors: Andrew T
authors: AT
authors: Dailey
authors: Tanvir F
authors: TF
authors: Choudhri
authors: Michael W
authors: MW
authors: Groff
authors: Jeffrey C
authors: JC
authors: Wang
authors: Sanjay S
authors: SS
authors: Dhall
authors: Michael G
authors: MG
authors: Kaiser
mesh_terms: D019317:Evidence-Based Medicine; D006801:Humans; D055959:Intervertebral Disc Degeneration / Q000473:pathology / Q000601:surgery*; D017116:Low Back Pain / Q000473:pathology / Q000601:surgery*; D008159:Lumbar Vertebrae / Q000473:pathology / Q000601:surgery*; D017410:Practice Guidelines as Topic; D013123:Spinal Fusion / Q000592:standards*
keywords: ODI = Oswestry Disability Index; SF-36 = 36-Item Short Form Health Survey; VAS = visual analog scale; low-back pain; lumbar fusion; lumbar spine; lumbar spondylosis; practice guidelines