Current Concepts Review - Lumbar Arthrodesis for the Treatment of Back Pain*
EDWARD N. HANLEY, JR., M.D.†; STEPHEN M. DAVID, M.D.†, CHARLOTTE, NORTH CAROLINA

Lumbar arthrodesis is a commonly performed operative procedure for the treatment of low-back pain; however, the indications, techniques, and results remain controversial and unclear. The frequency of spinal arthrodesis for the treatment of back pain is increasing in the United States, as are criticism of the procedure and the study of available information on its outcomes. The concept of spinal arthrodesis is based on experience with other regions of the body in which arthrodesis has been used to treat painful joints by eliminating motion. Initially, spinal arthrodesis was used for the treatment of infectious conditions, deformity, and trauma of the spine. On the basis of these successful experiences and because of technical advances in imaging, operative procedures, implants, and bone-grafting, the indications for spinal arthrodesis have been expanded in an attempt to control pain attributed to abnormal or unstable motion between one vertebra and an adjacent vertebra or pain due to mechanical degeneration of the intervertebral disc.

Much information on arthrodesis of the lumbar spine has been published, but most investigators have used nonstandardized criteria for inclusion of patients who were operated on for various diagnoses and whose outcomes were assessed with nonvalidated methods. Nevertheless, careful review of the available data may assist in determining which treatments are reasonable, which are unreasonable, and which are (or should be) considered investigational155.

Under ideal circumstances, spinal arthrodesis should be performed only after a specific pathoanatomical diagnosis has been identified as being responsible for the patient's symptoms. In addition, the natural history of the diagnosis and the appropriate timing of operative intervention should be understood. By limiting abnormal motion or removing the intervertebral disc, lumbar spinal arthrodesis can potentially minimize or eliminate the source of pain. Procedures that result in minimum disruption of tissue and restore the normal biomechanics and physiological …


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