Surgical Management of Lumbar Disc Herniation

Indications for Fusion

The American Association of Neurological Surgeons recommends against routine fusion at the time of primary lumbar disc excision for patients with radiculopathy, as Level III evidence shows no statistically significant difference in functional outcomes between discectomy alone versus discectomy with fusion (p = 0.31) 1, 2
Discectomy alone resulted in 70% return to work versus 45% in the fusion group, with a significant reduction in cost and complications 1, 2
Fusion is recommended for manual laborers or athletes with significant preoperative axial low-back pain, patients with preoperative lumbar instability, or those with radiographic instability or deformity 1, 2, 3

Reoperative discectomy alone provides satisfactory outcomes similar to primary disc excision, with good outcomes demonstrated in 69-85% of patients 3
Fusion at revision discectomy is recommended primarily for patients with associated lumbar instability, radiographic degenerative changes, chronic axial low-back pain, or spondylolisthesis 3, 4

The American Association of Neurological Surgeons advises against routine fusion for isolated disc herniation without instability, as the increase in morbidity, cost, and potential complications are not justified 1, 2, 4