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Of 47 articles,there were no randomized trials.Four nonrandomized studies compared surgery with and without fusion for herniated disks;three found no advantage for fusion.On average,68%of patients had a satisfactory outcome after fusion,but the range was wide(16%to 95%),and the satisfactory outcome rate was lower in prospective than in retrospective studies.The most frequently reported complications were pseudarthrosis (14%)and chronic pain at the bone graft donor site(9%).Clinical outcomes did not differ by diagnosis or fusion technique,but were worse in studies with a greater number of previously operated patients.Conclusions.-For several low back disorders no advantage has been demonstrated for fusion over surgery without fusion,and complications of fusions are common. Randomized controlled trials are needed to compare fusion,surgery without fusion,and nonsurgical treatments in rigorously defined patient groups. |
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herniated disc
herniated disc,lumbar
herniated disc,lumbar-conservative vs.surgical treat.of
herniated disc,lumbar-laminectomy
laminectomy,lumbar
review article
spinal fusion
treatment of neurologic disorder
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