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Seminars in Neurosurgery 2000; 11(2): 177-182
DOI: 10.1055/s-2000-13224
Copyright © 2000 by Thieme Medical Publishers, Inc., 333 Seventh Avenue, New York, NY 10001, USA. Tel.: +1(212) 584-4662

ARGUMENT AGAINST LUMBAR FUSION FOR LOW BACK PAIN

Henry F. Pallatroni, III, Perry A. Ball
  • Department of Surgery, Section of Neurosurgery, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire. Henry F. Pallatroni@Hitchcock.org
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Publication History

Publication Date:
31 December 2000 (online)

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ABSTRACT

The diagnosis and treatment of low back pain has always been a challenging undertaking. The etiology of the pain has been postulated to arise from a degenerated, disrupted intervertebral disc. The provocation discogram has become the standard diagnostic method for this entity. The provocation discogram is an imperfect test because of a potentially high false-positive rate and poor positive predictive value. Lumbar arthrodesis has become an accepted means of treating the ``painful disc.'' Surgical series with independent observers have reported favorable outcomes approaching only 50%. Improved methods of diagnosis along with more rigorous evaluation of surgical outcomes are needed if we are to consider lumbar arthrodesis a reasonable treatment alternative for low back pain.

KEYWORD

Lumbar fusion - provocation discogram - low back pain

REFERENCES

  • 1 Crock H. Internal disc disruption: a challenge to disc prolapse fifty years on.  Spine . 1985;  11 650-653
    PubMedSearch in Google Scholar
  • 2 Holt E. The question of lumbar discography.  J Bone Joint Surg . 1968;  50 720-726
    PubMedSearch in Google Scholar
  • 3 Walsh T R, Weinstein J N, Spratt K F, Lehmann T R, Aprill C, Sayre H. Lumbar Discography in normal subjects.  J Bone Joint Surg . 1990;  72 1081-1088
    PubMedSearch in Google Scholar
  • 4 Carragee E J, Tanner C M, Yang B, Brito J L, Truong T. False-positive findings on lumbar discography.  Spine . 1999;  24 2542-2547
    CrossrefPubMedSearch in Google Scholar
  • 5 Simmons J W, Aprill C N, Dwyer A P, Brodsky A E. A reassessment of Holt's data on the question of lumbar discography.  Clin Ortho Rel Res . 1988;  237 120-124
    PubMedSearch in Google Scholar
  • 6 Schwarzer A C, Aprill C N, Derby R, Fortin J, Kine G, Bogduk N. The prevalence and clinical features of internal disc disruption in patients with chronic low back pain.  Spine . 1995;  20 1878-1883
    CrossrefPubMedSearch in Google Scholar
  • 7 Rhyne A L, Smith S E, Wood K E, Darden B V. Outcome of unoperated discogram-positive low back pain.  Spine . 1995;  20 1997-2001
    PubMedSearch in Google Scholar
  • 8 Calhoun E, McCall I W, Williams L, Cassar Pullicino N V. Provocation discography as a guide to planning operations on the spine.  J Bone Joint Surg . 1988;  70 267-271
    PubMedSearch in Google Scholar
  • 9 Newman M H, Grinstead G L. Anterior lumbar interbody fusion for internal disc disruption.  Spine . 1992;  17 831-833
    PubMedSearch in Google Scholar
  • 10 Blumenthal S L, Baker J, Dosset A, Selby D K. The role of anterior lumbar fusion for internal disc disruption.  Spine . 1988;  13 566-569
    PubMedSearch in Google Scholar
  • 11 Kuslich S D, Ulstrom C L, Griffith S L, Ahern J W, Dowdle J D. The Bagby and Kuslich method of lumbar interbody fusion.  Spine . 1998;  23 1267-1279
    CrossrefPubMedSearch in Google Scholar
  • 12 Parker L M, Murrell S ER, Boden S D, Horten W C. The outcome of posterolateral fusion in highly selected patients with discogenic low back pain.  Spine . 1996;  21 1909-1917
    CrossrefPubMedSearch in Google Scholar
  • 13 Gertzbein S D, Hollopeter M, Hall S D. Analysis of circumferential lumbar fusion outcome in the treatment of degenerative disc disease of the lumbar spine.  J Spinal Disord . 1998;  11 472-478
    PubMedSearch in Google Scholar
  • 14 Leufven C, Nordwall A. Management of chronic disabling low back pain with 360 degree fusion.  Spine . 1999;  24 2042-2045
    CrossrefPubMedSearch in Google Scholar
  • 15 Greenough C G, Peterson M D, Hadlow S, Fraser R D. Instrumented posterolateral lumbar fusion.  Spine . 1998;  23 479-486
    Search in Google Scholar
  • 16 Wetzel T, LaRocca S, Lowery G, Aprill C. The treatment of lumbar spine pain syndromes diagnosed by discography.  Spine . 1994;  19 792-800
    PubMedSearch in Google Scholar
  • 17 Hinkley B S, Jaremko M E. Effects of 360-degree lumbar fusion in a workers' compensation population.  Spine . 1997;  22 312-323
    CrossrefPubMedSearch in Google Scholar
  • 18 Franklin G M, Haung J, Heyer N J, McKeefrey S P, Picciano J F. Outcome of lumbar fusion in Washington state workers' compensation.  Spine . 1994;  19 1897-1904
    PubMedSearch in Google Scholar
  • 19 Whitecloud T S, Castro F P, Brinker M R, Hartzog C W, Ricciardi J E, Hill C. Degenerative conditions of the lumbar spine treated with intervertebral titanium cages and posterior instrumentation for circumferential fusion.  J Spinal Disord . 1998;  11 479-486
    PubMedSearch in Google Scholar
  • 20 Rahm M D, Hall B B. Adjacent-segment degeneration after lumbar fusion with instrumentation: a retrospective study.  J Spinal Disord . 1996;  9 392-400
    PubMedSearch in Google Scholar
  • 21 Deyo R A, Cherkin D, Conrad D, Volinn E. Cost, controversy, crisis: low back pain and the health of the public.  Annu Rev Public Health . 1991;  12 141-1561
    CrossrefPubMedSearch in Google Scholar