title: Guideline update for the performance of fusion procedures for degenerative disease of the lumbar spine. Part 8: lumbar fusion for disc herniation and radiculopathy.
abstract: Patients suffering from a lumbar herniated disc will typically present with signs and symptoms consistent with radiculopathy. They may also have low-back pain, however, and the source of this pain is less certain, as it may be from the degenerative process that led to the herniation. The surgical alternative of choice remains a lumbar discectomy, but fusions have been performed for both primary and recurrent disc herniations. In the original guidelines, the inclusion of a fusion for routine discectomies was not recommended. This recommendation continues to be supported by more recent evidence. Based on low-level evidence, the incorporation of a lumbar fusion may be considered an option when a herniation is associated with evidence of spinal instability, chronic low-back pain, and/or severe degenerative changes, or if the patient participates in heavy manual labor. For recurrent disc herniations, there is low-level evidence to support the inclusion of lumbar fusion for patients with evidence of instability or chronic low-back pain.
authors: Department of Orthopaedic Surgery, Keck School of Medicine, University of Southern California, Los Angeles, California;
authors: Jeffrey C
authors: JC
authors: Wang
authors: Andrew T
authors: AT
authors: Dailey
authors: Praveen V
authors: PV
authors: Mummaneni
authors: Zoher
authors: Z
authors: Ghogawala
authors: Daniel K
authors: DK
authors: Resnick
authors: William C
authors: WC
authors: Watters
authors: Michael W
authors: MW
authors: Groff
authors: Tanvir F
authors: TF
authors: Choudhri
authors: Jason C
authors: JC
authors: Eck
authors: Alok
authors: A
authors: Sharan
authors: Sanjay S
authors: SS
authors: Dhall
authors: Michael G
authors: MG
authors: Kaiser
mesh_terms: D019317:Evidence-Based Medicine; D006801:Humans; D007405:Intervertebral Disc Displacement / Q000473:pathology / Q000601:surgery*; D008159:Lumbar Vertebrae / Q000473:pathology / Q000601:surgery*; D017410:Practice Guidelines as Topic; D011843:Radiculopathy / Q000473:pathology / Q000601:surgery; D013123:Spinal Fusion / Q000592:standards*
keywords: JOA = Japanese Orthopaedic Association; LHNP = lumbar herniated nucleus pulposus; ODI = Oswestry Disability Index; fusion; herniated disc; lumbar spine; practice guidelines