New guidelines unveiled for fusions for degenerative disease of the lumbar spine

The Journal of Neurosurgery: Spine recently announced the publication of updated guidelines from the American Association of Neurological Surgeons Congress of Neurological Surgeons Joint Section on Disorders of the Spine and Peripheral Nerves with regard to fusion procedures for degenerative disease of the lumbar spine.

The update replaces guidelines published previously in the journal in 2005, according to a press release.

“These guidelines are not intended to provide rigid treatment algorithms. Instead, it is hoped that this update will serve as a comprehensive review of the current state of the literature and provide the reader with a foundation to formulate an appropriate individualized treatment plan for a given patient,” the guideline authors stated in the press release. “Furthermore, it is the intent of any guideline to identify current limitations of the literature and stimulate further investigational research.”

The updated guidelines are split into 17 different topics, similar to what was done with the first publication. The topics sinclude radiographic assessment of the fusion status; lumbar fusion for stenosis without spondylolisthesis; interbody techniques for lumbar fusion; injection therapies, low-back pain, and lumbar fusion; electrophysiological monitoring and lumbar fusion and bone graft extenders and substitutes as an adjunct for lumbar fusion.

The methodology used to formulate the updated guidelines differs slightly from that used in the 2005 publication, as noted in the press release. The authors state the change was made to provide a more objective evaluation and to ease communication between subspecialty organizations. In brief, relevant papers were examined and classified according to the strength of evidence they provide. Recommendations for clinical practice were then made according to the levels of evidence on which they rest.