To Fuse or Not to Fuse: That’s the Question

Over the last few decades, significant advances have been made with regard to fusion technologies in the lumbar spine. The advent of pedicle screw fixation, lateral interbody grafting techniques, recombinant human bone morphogenetic proteins, and minimally invasive surgical approaches has resulted in a significant increase in the number of fusion procedures annually. As an aging, active population continues to expand, more patients seek appropriate therapies to alleviate pain, restore function, and maintain their active lifestyles. While the technologies and techniques available to the spine surgeon have improved and expanded, the debate continues over the appropriate indications for fusion in the setting of lumbar degenerative disc disease. The purpose of this chapter is to review current evidence for lumbar spinal fusion procedures and provide recommendations for evaluation, clinical workup, and surgical decision making in this challenging patient population.