Lumbar Fusion: A Defensible Option for Discogenic Low Back Pain?

Chronic low back is one of the most common reasons that patients seek medical attention. There is little agreement on how to treat pain that persists despite an adequate trial of conservative care. When the pain generator can be determined, a logical and targeted treatment plan can be implemented. Diskography can be used to identify an abnormal, painful disk, although the value and safety of this diagnostic tool have been debated. Lumbar fusion for chronic low back pain remains a contentious issue that has been widely debated; however, many studies have inherent flaws that weaken their conclusions. Procedures that do not include interbody fusion ignore the role of the painful disk and might be associated with poorer results. With proper attention to selecting the correct patient, identifying the correct diagnosis, and choosing the correct procedure, good outcomes can be achieved with lumbar fusion for discogenic low back pain.