ARGUMENT AGAINST LUMBAR FUSION FOR LOW BACK PAIN

The diagnosis and treatment of low back pain has always been a challenging un-dertaking. The etiology of the pain has been postulated to arise from a degenerated, disrupted intervertebral disc. The provocation discogram has become the standard diagnostic method for this entity. The provocation discogram is an imperfect test because of a potentially high false-positive rate and poor positive predictive value. Lumbar arthrodesis has become an accepted means of treating the “painful disc.” Surgical series with independent observers have reported favorable outcomes approaching only 50%. Improved methods of diagnosis along with more rigorous evaluation of surgical outcomes are needed if we are to consider lumbar arthrodesis a reasonable treatment alternative for low back pain.