Does the Fusion of a Lumbar Disk Herniation Improve the Clinical Outcome? An Investigation With a Minimum 10-Year Follow-up

Study Design: A retrospective long-term (minimum 10 y) followup and comparative study. Objective: To compare the clinical outcome of surgically treated primary lumbar disk herniation (LDH) by conventional discectomy alone and discectomy with posterolateral fusion without instrumentation. Summary of Background Data: Primary LDH is usually treated by discectomy alone. The long-term outcome of discectomy alone is generally satisfactory. However, the superiority of a discectomy alone in comparison with a discectomy with fusion for primary LDH has yet to be determined. Methods: Conventional discectomy without fusion was performed in 39 patients in hospital A (without-fusion group) and conventional discectomy with posterolateral fusion without instrumentation was performed in 109 patients in hospital B (with-fusion group). The subjective symptoms (analgesic use, continuing gait time, 4-grade modified outcome criteria, numerical rating scale of pain and satisfaction with the operation, and the Japanese version of the Roland-Morris Disability Questionnaire) and objective symptoms (straight leg raising test, manual muscle test, and sensory disturbance) were assessed. Results: There were no differences detected in the subjective and objective symptoms between the without-fusion and with-fusion group. Conclusions: Routine fusion surgery for a primary LDH was therefore found to have no apparent benefit even in the longterm outcome.