Fusion Fact FindingLow back pain that doesn't go away after six months is called chronic. Chronic low back pain is now one of the most common reasons for early retirement in the United States and other western countries.
Doctors are under increased pressure to successfully treat back pain, as more and more adults suffer from this problem. As a result, the number of spinal fusions done in the last 15 years has increased. Many physicians debate just who should have a spinal fusion and what kind of fusion should be done.
Using bone graft to fuse two or more bones together in the low back area is one option. Placing the graft along the back sides of the spinal column is a procedure called posterolateral fusion. Another method of fusion is to add a screw as an extra support for the spine and to increase the success of the fusion. Until recently, no one knew which method was better.
Doctors in Denmark carried out a study to see whether posterolateral fusion worked better by adding screws. They studied 129 people over a period of five years. For the most part, there were no major differences in the final results with the two methods. The only exception was for back patients needing fusion due to degenerative loosening within two or more spine bones. These patients fared better with addition of screws.
Adding a screw during lumbar fusion increases the operating time and amount of blood loss. In most cases there is no advantage to having a spinal fusion with addition of the screw. Depending on the cause of their chronic low back pain, patients needing fusion surgery may benefit by having posterolateral fusion alone, without the addition of screws. Doctors use studies like this one to choose the best treatments for each patient.
Finn Bjarke Christensen, MD, PhD, et al. Long-Term Functional Outcome of Pedicle Screw Instrumentation as a Support for Posterolateral Spinal Fusion. In Spine. June 15, 2002. Vol. 27. No. 12. Pp. 1269-1277.
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