State of the union: a review of lumbar fusion indications and techniques for degenerative spine disease

Abstract

Lumbar fusion is an accepted and effective technique for the treatment of lumbar degenerative disease. The practice has evolved continually since Albee and Hibbs independently reported the first cases in 1913, and advancements in both technique and patient selection continue through the present day. Clinical and radiological indications for surgery have been tested in trials, and other diagnostic modalities have developed and been studied. Fusion practices have also advanced; instrumentation, surgical approaches, biologics, and more recently, operative planning, have undergone stark changes at a seemingly increasing pace over the last decade. As the general population ages, treatment of degenerative lumbar disease will become a more prevalent-and costlier-issue for surgeons as well as the healthcare system overall. This review will cover the evolution of indications and techniques for fusion in degenerative lumbar disease, with emphasis on the evidence for current practices.

Keywords: ALIF = anterior lumbar interbody fusion; ALL = anterior longitudinal ligament; CFRP = carbon fiber reinforced PEEK; LLIF = lateral lumbar interbody fusion; ODI = Oswestry Disability Index; PEEK = polyetheretherketone; PLIF = posterior lumbar interbody fusion; PS = pedicle screw; SPORT = Spine Patient Outcomes Research Trial; TFS = transfacet screw; TL = translaminar; TLIF = transforaminal lumbar interbody fusion; cPS = cortical pedicle screw; degenerative spine disease; lumbar fusion; lumbar spondylosis.