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Indication for Lumbar Spinal Fusion

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Surgery for Low Back Pain

Abstract

Surgical treatment in general and fusion in particular are a continuous concern in the discussion about the treatment options for low back pain (LBP). Since LBP is a symptom and not a diagnosis, the question what the indications for surgery really are cannot be answered with a simple guideline. Surgery may have a valuable place in the treatment armentarium, when we can demonstrate that back pain is either caused by a so called instability within a motion segment, by a malalignement of the lumbar spine with severe secondary rather diffuse back pain as an expression of fatigue, or by an active degenerative destruction of the intervertebral joints and /or disks. Beyond this major indication for fusion, there are pathologies of the lumbar spine which are characterized by an unstable or hypermobile motion segment causing mostly movement and activity dependent LBP. The spondylolysis at L5 with a spondylolisthesis or a classical degenerative spondylolisthesis at L4/5 or L3/4 may be the cause of it. Finally, lumbar spinal deformities, a pathological entity becoming more and more frequent in the industrialized world due to the increasing aging of the population, may form a major indication for surgery. Here, the sagittal malalignement is more frequently linked to severe low back than a malalignement in the frontal plane. Clearly fusions may be indicated in very specific pathologies where the LBP is a mixture between localized destruction of articular/discal components, mechanical instability of one or more motion segments, and malalignement like in trauma with fracture of the lumbar spine or tumor involvement with pathological fractures of the vertebra and/or tumor compression of the neural structures. Also, osteoporotic fractures in the elderly patient play a relevant role in LBP, which, however, is increasingly treated with vertebroplasties rather than fusions. Diffuse LBP without a pathomorphological correlation or an explainable functional deficit is no indication for fusions.

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Authors and Affiliations

  1. Center for Orthopaedic Research, University of Bern, Stauffenbachstrasse 78, 3014, Bern, Switzerland

    Max Aebi

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  1. Max Aebi
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Correspondence to Max Aebi .

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Editors and Affiliations

  1. Avenue Coghen 21, Bruxelles, 1180, Belgium

    Marek Szpalski

  2. Algemeen Ziekenhuis Monica, Eeuwfeestkliniek, Harmoniestraat 68, Antwerpen, 2018, Belgium

    Robert Gunzburg

  3. Dept. Orthopaedic Surgery, Sahlgrenska Univ.Hospital/Sahlgrenska, Göteborg, 413 45, Sweden

    Björn L. Rydevik

  4. Hopital Pellegrin, CHU Bordeaux, place Amalie Raba Leon, Bordeaux CX, 33076, France

    Jean-Charles Le Huec

  5. München-Harlaching, Orthopädische Klinik, Harlachinger Str. 51, München, 81243, Germany

    H. Michael Mayer

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Aebi, M. (2010). Indication for Lumbar Spinal Fusion. In: Szpalski, M., Gunzburg, R., Rydevik, B., Le Huec, JC., Mayer, H. (eds) Surgery for Low Back Pain. Springer, Berlin, Heidelberg. https://doi.org/10.1007/978-3-642-04547-9_15

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  • DOI: https://doi.org/10.1007/978-3-642-04547-9_15

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