The present status of spinal fusion in the treatment of lumbar intervertebral joint disorders.

Every type of fusion has its enthusiastic supporters. Unfortunately, the literature includes comparative analyses of various fusion procedures. Much of the effort spent in the clinical assessment of spinal fusion must be reinvested; neither the indications for diskectomy nor spinal fusion have been sufficiently clear-cut and accurately recorded. Moreover, spinal fusions often have not been applied to treat the disorder or to correct the deformity. It is essential at the outset to establish the mechanical fault; this is achieved only by a thorough understanding of the underlying pathologic lesion. Diagnosis follows a careful history and physical examination assisted by plain radiographs, lateral radiographs in flexion and extension, radiographs (anteroposterior in left and right lateral bending), and by information obtained from the CAT scan. We have designed a protocol for a prospective investigation wherein a specific fault with a specific etiology and pathologic anatomy is identified and submitted to a surgical procedure in a specified sequence. In future reviews, emphasis must be paid to selection of patients, the individual joint requiring stabilization and the type of fusion performed. Only then can we put this theoretically effective procedure to the acid test of objective clinical evaluation.