Systematic review of the effect of fusion added to discectomy compared with discectomy alone for lumbar disk prolapse surgery
Ricardo Vieira Botelho1,2, Thiago Lusvarghi Cardoso2, Wanderley Marques Bernardo3,4
1Neurosurgical Service, Hospital do Servidor Público do Estado de São Paulo; 2Faculdade de Medicina, Universidade Cidade de São Paulo (UNICID); 3Faculdade de Medicina, Universidade Lusíadas (UNILUS), Santos; 4Hospital das Clinicas da Universidade de São Paulo, São Paulo, Brazil
Introduction: Lumbar disk herniation is the pathologic condition most commonly responsible for radicular pain, and the condition for which lumbar surgery is performed most frequently. Fusion in the lumbar spine, which is associated with surgical treatment of disk prolapse, has been discussed since the beginning of the contemporary era of lumbar spine surgery. It is questionable whether or not fusion would address the potential effects in the evolutive degenerative process in the years following the surgery. A systematic review of controlled studies was conducted to clarify the effect of fusion.
Methods: An evidenced-based practice systematic method called the PICO was used to search the best evidence in MEDLINE using PubMed tools.
Results: Only retrospective comparative studies were found, and they revealed superior long-term results in outcomes such as satisfactory rates, recurrence of disk herniation, and chronic low back rates for a fusion group of patients.
Discussion: Several papers have concluded that there is conflictive evidence of the role for fusion in surgery for lumbar herniated disks. For the first time, this conflictive evidence has been clarified by means of systematic review and meta-analysis.
Conclusion: There were substantial statistical heterogeneous results favoring spinal fusion in surgery for lumbar disk herniation, producing conflictive evidence to support fusion as an option.
Keywords: intervertebral disk displacement, lumbar vertebrae, surgical procedures, discectomy, spinal fusion, treatment outcome
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