Updated guidelines covering fusion procedures for degenerative disease of the lumbar spine

July 1, 2014

Experts in the spine surgery community—neurosurgeons and orthopedic surgeons—banded together to evaluate the recent literature on lumbar spine fusion procedures and to publish up-to-date evidence-based recommendations on their use.

The Journal of Neurosurgery: Spine is pleased to announce today's publication of the American Association of Neurological Surgeons/Congress of Neurological Surgeons Joint Section on Disorders of the Spine and Peripheral Nerves' updated guidelines for the performance of fusion procedures for degenerative disease of the lumbar spine. This update replaces the first set of guidelines published in the same journal in 2005.

Spinal fusion procedures constitute an established and successful therapy for patients with pain and/or neurological deficits due to degenerative diseases of the lumbar spine. It has been nine years since the original guidelines were published, and both knowledge and clinical practices change over time. The authors acknowledge, "all are evolving documents that require periodic updating."

Similar to the first publication, the updated guidelines document is separated into parts focusing on the following topics:

1. Introduction and methodology

2. Assessment of functional outcome following lumbar surgery

3. Assessment of economic outcome

4. Radiographic assessment of the fusion status

5. Correlation between radiographic outcome and function

6. Discography for patient selection

7. Lumbar fusion for intractable low-back without stenosis or spondylolisthesis

8. Lumbar fusion for disc herniation and radiculopathy

9. Lumbar fusion for stenosis with spondylolisthesis

10. Lumbar fusion for stenosis without spondylolisthesis

11. Interbody techniques for lumbar fusion

12. Pedicle screw fixation as an adjunct to posterolateral fusion

13. Injection therapies, low-back pain, and lumbar fusion

14. Brace therapy as an adjunct to or substitute for lumbar fusion

15. Electrophysiological monitoring and lumbar fusion

16. Bone graft extenders and substitutes as an adjunct for lumbar fusion

17. Bone growth stimulators as an adjunct for lumbar fusion

The methodology used to formulate the updated guidelines differs slightly from that used in the 2005 publication. The authors state that the change was made to provide a more objective evaluation and to ease communication between subspecialty organizations. In brief, relevant papers were examined and classified according to the strength of evidence they provide. Recommendations for clinical practice were then made according to the levels of evidence on which they rest.

The topic chapters in the updated guidelines provide graded recommendations, a rationale for the procedure, the search criteria used to identify relevant literature, and a section on the scientific foundations for the recommendation. Tables summarizing salient papers in the literature and specifying the levels of evidence they provide are also included. Issues that may warrant further investigation are also listed.

In summarizing their aims, the authors state, "These guidelines are not intended to provide rigid treatment algorithms. Instead, it is hoped that this update will serve as a comprehensive review of the current state of the literature and provide the reader with a foundation to formulate an appropriate individualized treatment plan for a given patient. Furthermore it is the intent of any guideline to identify current limitations of the literature and stimulate further investigational research."

Explore further: Spinal fusion surgery not associated with stroke

Related Stories

Spinal fusion surgery not associated with stroke

December 10, 2012

(HealthDay)—Undergoing spinal fusion surgery does not affect the risk of stroke within the three years after surgery, according to a study published in the December issue of the European Spine Journal.

Surgeons can up outcomes for work-related lumbar surgery

February 21, 2014

(HealthDay)—In patients with chronic disabling occupational lumbar disorder (CDOLD) and workers' compensation claims, lumbar fusion outcomes can be improved if opioid dependence and excessive length of disability after ...

More lumbar Sx complications at teaching hospitals

March 12, 2014

(HealthDay)—Patients undergoing lumbar spine surgery at teaching hospitals incur longer hospitalizations and have more postoperative complications compared to those treated at nonteaching hospitals, according to a study ...

Recommended for you

A recipe for long-lasting livers

April 22, 2015

People waiting for organ transplants may soon have higher hopes of getting the help that they need in time. Researchers at the RIKEN Center for Developmental Biology have developed a new technique that extends the time that ...

Surgeon to offer ideas on a way to do human head transplants

February 26, 2015

Sergio Canavero of the Turin Advanced Neuromodulation Group has made it known that he intends to announce at this summer's American Academy of Neurological and Orthopedic Surgeons meeting, that he believes he has put together ...

New tool helps guide brain cancer surgery

July 3, 2014

A tool to help brain surgeons test and more precisely remove cancerous tissue was successfully used during surgery, according to a Purdue University and Brigham and Women's Hospital study.

New imaging technique sharpens surgeons' vision

February 11, 2014

Which superhuman power would you choose for help on the job? For Dr. Julie Margenthaler, it's a technology that brings to mind X-ray vision, used for the first time Monday during an operation to remove a patient's lymph node.

0 comments

Please sign in to add a comment. Registration is free, and takes less than a minute. Read more

Click here to reset your password.
Sign in to get notified via email when new comments are made.