Does fusion matter in lumbar spine surgery?
Spine surgeons spend a lot of time talking and worrying about whether or not we can achieve a proper fusion (the surgically induced bony union of adjacent spine levels) following spine surgery. Much of this worry seems to rise from the orthopedic experience where fusion of the long bones of the extremities is clearly important. Yet in spine surgery, while the importance of decompressing the neural structures (spinal cord and nerve roots) is unequivocal, the utility of fusion has become less clear. There are 3 Class I studies (prospective, randomized controlled trials) that have sought to answer the question of whether or not fusion matters in lumbar spine surgery. The first looked at a group of 114 patients undergoing lumbar fusion for degenerative disc disease, stenosis, scoliosis or spondylolisthesis. All patients were treated with decompression (laminectomies of the lumbar spine) and then randomized to one of three groups: autologous bone graft (ABG), ABG plus semirigid pedicle scre
