The Role of Fusion for Discogenic Axial Back Pain Without Associated Leg Pain, Spondylolisthesis or Stenosis: An Evidence-Based Review

The objective of this review was to examine the randomized controlled trials evaluating fusion surgery for discogenic axial back pain without associated leg pain, spondylolisthesis, or stenosis. Six studies were reviewed: 4 that considered spinal fusion in comparison with nonoperative treatment, and 2 that considered fusion in comparison with artificial disc replacement. We found that methodological difficulties limit the ability to draw definitive conclusions, but that fusion appears superior to unstructured nonoperative treatment, similar to structured nonoperative treatment, and similar to short-term results of artificial disc replacement. Further long term, well-constructed randomized controlled trials are warranted.