title: Posterior lumbar fusion: choice of approach and adjunct techniques.
abstract: The choice among the many options of approach and adjunct techniques in planning a posterior lumbar fusion can be problematic. Debates remain as to whether solid fusion has an advantage over pseudarthrosis regarding long-term symptom deterioration and whether an instrumented or a noninstrumented approach will best serve clinically and/or cost effectively, particularly in elderly patients. Increased motion resulting in higher rates of nonunion and the use of nonsteroidal anti-inflammatory drugs have been studied in animal models and are presumed risk factors, despite the lack of clinical investigation. Smoking is a proven risk factor for pseudarthrosis in both animal models and level III clinical studies. Recent long-term studies and image/clinical assessment of lumbar fusions and pseudarthrosis show that, although imaging remains a key area of difficulty in assessment, including an instrumented approach and a well-selected biologic adjunct, as well as achieving a solid fusion, all carry important long-term clinical advantages in avoiding revision surgery for nonunion.
authors: Charla R
authors: CR
authors: Fischer
authors: Aaron R
authors: AR
authors: Ducoffe
authors: Thomas J
authors: TJ
authors: Errico
mesh_terms: D018786:Bone Substitutes / Q000627:therapeutic use; D016025:Bone Transplantation / Q000379:methods; D004599:Electric Stimulation Therapy; D019317:Evidence-Based Medicine; D006801:Humans; D008159:Lumbar Vertebrae / Q000601:surgery*; D018579:Patient Selection; D011542:Pseudarthrosis / Q000601:surgery; D012307:Risk Factors; D013122:Spinal Diseases / Q000601:surgery*; D013123:Spinal Fusion / Q000295:instrumentation / Q000379:methods*
chemical_list: D018786:Bone Substitutes