Guidelines for the performance of fusion procedures for degenerative disease of the lumbar spine. Part 1: introduction and methodology

As scientific understanding of the pathophysiology of degenerative disease of the lumbar spine has increased, the possibilities for correcting the underlying problem and the resulting improvement in clinical function have expanded exponentially. Fueled by advances in material technology and surgical technique, treatment of greater numbers of individuals suffering from lumbar spinal disease has proliferated. Using data from the National Hospital Discharge Survey, Deyo and colleagues4 described a 200% increase in the frequency of lumbar fusion procedures in the 1980s. Davis3 observed that the age-adjusted rate of hospitalization for lumbar surgery and lumbar fusion increased greater than 33% and greater than 60%, respectively, from 1979 to 1990. Lumbar fusion has been described as a treatment of symptomatic degenerative disc disease, spinal stenosis, spondylolisthesis, and degenerative scoliosis. Lumbar fusion has been performed to treat acute and chronic lowback pain, radiculopathy, and spinal instability.