Critical analysis of trends in fusion for degenerative disc disease over the past 20 years - Influence of technique on fusion rate and clinical outcome

Study Design. Critical analysis of the results reported in published literature. Objectives. The purpose of this study was to evaluate whether various technical advancements have affected the outcome of lumbar spinal fusion for degenerative disease by critically analyzing the available literature from the past two decades. Summary of Background Data. To improve fusion rate and clinical outcome, various surgical options for lumbar spinal fusion for degenerative disc disorders have been introduced over the past 20 years. However, an important fundamental question still remains: What has been the impact of these new techniques and innovations on surgical results? Methods. A comprehensive computer search of the English literature from 1979 to 2000 concerning lumbar/ lumbosacral spinal fusion was performed using the keywords degenerative, lumbar, and fusion. Results. Numerous deficiencies were noted in the reviewed literature. Nearly half of the studies failed to specify methodologic design, and documentation of brace use, graft source, fusion location, and fusion rate was missing in 38, 10, 2, and 4 of the 84 articles reviewed, respectively. From the data gathered, a noticeable trend toward the increasing use of internal fixation was noted, accounting for 23% of fusions in the 1980s versus 41% in the 1990s. Despite this trend, an improvement in overall fusion rate or clinical outcome could not be demonstrated. Conclusions. Numerous technologic advancements in lumbar spine fusion have been made over the past 20 years. Future advances in care are dependent on review of reported results. The numerous deficiencies detected in the analyzed literature herald the necessity for a uniform system of outcomes reporting containing a core of critical demographic, perioperative, and postsurgical information. Although a shift toward a greater use of technology was noted in the published literature, the clinical benefit of this trend remains unclear.