The treatment of degenerative lumbar disorders: A critical review of the literature

Study Design. A literature review. Objectives. To clarify the surgical indications for spinal fusion in the various lumbar conditions. Summary of Background Data. This article summarizes the published literature regarding the treatment of lumbar degenerative conditions. Retrospective and prospective studies regarding the treatment of nonspecific low back pain, disc herniation, spinal stenosis, isthmic spondylolisthesis, facet syndrome, discogenic pain, and lumbar spondylosis are reviewed. Methods. A review of the English Medical Literature regarding the treatment of low back pain, disc herniation, spinal stenosis, spondylolisthesis, discogenic pain, and lumbar spondylosis was performed. Results and Conclusions. Past research does not support the use of spinal fusion for nonspecific low back pain. Fusion is rarely indicated for primary disc herniation but may have a role in recurrent herniations. Specific guidelines regarding fusion in spinal stenosis and spondylolisthesis are described based on the literature. Less rigorous data are presented for indications for fusion in facet joint syndrome, discogenic pain, and lumbar spondylosis. Spinal fusion plays an important role in the treatment of degenerative disorders of the lumbar spine, and the indications for this procedure can be refined by reviewing the existing literature.