Spinal Instrumentation in the Management of Degenerative Disorders of the Lumbar Spine

Abstract

The use of spinal instrumentation as an adjunct to fusion for the treatment of degenerative disorders of the lumbar spine is controversial. Instrumented lumbar fusions, in specific instances, may improve patient outcomes. For patients undergoing single level primary lumbar arthrodesis, the available data do not conclusively support the efficacy of spinal instrumentation. However, in the setting of previous failed lumbar surgery, iatrogenic or degenerative lumbar spondylolisthesis, spinal instrumentation may be useful as an adjunct to fusion. Possible advantages associated with the use of instrumentation include: correction of deformity in frontal and sagittal planes; decreased pseudarthrosis rates; prevention of progression of spondylolisthesis, and provision of spinal stability in the absence of intact posterior elements. Complications associated with the use of instrumentation include: increased cost; increased operative times; increased infection rate; increased reoperation rate; and a steep learning curve. Therefore, when instrumentation is to be used, the benefits must outweigh the risks. These risks can be minimized by the judicious use of instrumentation by experienced surgeons, for specific indications as supported by the literature.