A common type of spine fusion surgery is performed for mechanical low back pain. This type of mechanical lower back pain occurs with increased activities and an often times is associated with degenerative changes in the discs (such as degenerative disc disease). At other times it may be due to a low-grade slippage of the spine (such as degenerative spondylolisthesis and isthmic spondylolisthesis). The most important factor in treatment of these types of low back pain is making a specific and appropriate anatomic diagnosis.
When considering the indications for lumbar spine fusion surgery, low back pain that lasts for more than six months is the most general indication. The indications for fusing the low back occur primarily in situations where there is a large deformity (such as scoliosis) or, more commonly, for back pain that does not get better with time or non-surgical treatment, such as:
- Mechanical back pain (usually attributed to disc degeneration, called degenerative disc disease)
- Spinal stenosis (where there is an associated deformity)
- Isthmic spondylolisthesis
There are important subtleties within the general indications. For example, spine fusion surgery is more reliable to address pain from degenerative disc disease with instability than for disc degeneration without instability.
Determining where the pain arises is the greatest challenge in fusion of the low back. The steps involved in evaluating the source of pain include a thorough patient history, physical exam, and diagnostic studies.