Current Treatment Strategies for the Painful Lumbar Motion Segment

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Abstract
Study Design.: Review of the literature. Objectives.: We discuss the indications and contraindications for posterolateral lumbar fusion and posterior approaches to lumbar interbody fusion. We also review the advances in minimal access surgical techniques, graft materials, and osteobiologics. Summary of Background Data.: Previously published data and our own surgical experience form the basis of this report. Methods.: A Pub Med online internet search for the keywords was performed. The pertinent articles were then cited. Results.: Posterior interbody fusion techniques have theoretical and demonstrable advantages over posterolateral fusion, but the former is also associated with greater morbidity. There are several approaches one may use to perform posterior interbody fusion, as well as multiple minimally invasive techniques and interbody spacer graft options. Bone morphogenetic protein offers an attractive alternative for achieving fusion. Conclusion.: Fusion of painful motion segments is widely used to treat patients with degenerative low back pain. Successful arthrodesis may be achieved using either posterolateral fusion with pedicle screw fixation or posterior interbody fusion, depending on the patient's situation. These techniques may be accomplished with a variety of minimal access strategies and various graft and spacer technologies. The modern spine surgeon should be proficient in using all these options to treat the painful lumbar motion segment.