Lumbar spine fusion: Types, principles, and outcomes

Lumbar spine fusion rates have increased significantly over the past couple of decades. Spinal fusion procedures are performed for fractures, degenerative conditions, and deformity. The outcomes of these procedures are affected by many factors-both patient and surgeon specific. Therefore, the proper selection of surgical procedures must be carefully individualized on the basis of both clinical and radiographic factors. There have been significant recent advances in the basic science, surgical technique, and instrumentation used to obtain a successful lumbar spinal fusion. These advances continue to be based on the same basic tenants of preparing a proper biologic fusion bed and minimizing motion at the fusion site. New growth factors to enhance the biology and more rigid instrumentation to prevent motion at the fusion site are goals that the surgeon along with the industry has continued to pursue. The recent introduction of minimally invasive surgery also drives the surgeon to attempt both to reduce postoperative pain, blood loss, and length of hospital stay. The results of these recent technologies, however, remain to be answered. This is a review of lumbar spinal fusion, focusing on the basic principles necessary for a successful outcome, the multitude of approaches and types available to the spinal surgeon, possible complications and also recent advances and emerging technology that may provide better fusion rates and hopefully patient satisfaction.