Functional results after anterior lumbar fusion at L5-S1 in patients with normal and abnormal MRI scans.

The debate continues as to which patient responds best to surgical versus nonsurgical intervention for painful degenerative disc syndrome. Discography is often used as the basis for that decision. In a review of 53 cases followed for an average of 20 months after surgery, only 50% of patients with type I (contained) discography and normal magnetic resonance imaging findings were found to be improved. In those patients with types II and III (noncontained) discography and abnormal magnetic resonance imaging scans, a 75% success rate was seen. There was an overall 80% fusion rate for all patients who underwent anterior lumbar fusion at L5-S1. Average age was 34 years, with average length of disability from low-back pain of 11 months. All patients were placed in a similar presurgery and postsurgery rehabilitation protocol and had failed nonsurgical treatment options. In this matched group of patients, those with abnormal magnetic resonance imaging scans and abnormal discography, clearly fared better, with a 75% percent success rate versus 50% success rate in those with normal magnetic resonance imaging findings. This series raises the question as to whether those patients with normal magnetic resonance imaging findings are surgical candidates.