Surgeons Attempt to Classify Lumbar Fusion Patients
This study points out the fact that surgeons can't agree on when lumbar fusion should be used. The study was set up so that 19 spine surgeons were given a proposed classification system to choose patients for lumbar fusion. Each surgeon looked at 32 cases. Each patient had some degree of lumbar degenerative disease.

A classification system helps define which patients would benefit from a spinal fusion. Once patients are selected for fusion, surgeons could decide which method would work best for each person. And a classification system would allow researchers to compare results of each group.

Patients were divided first into two groups based on whether or not they had a previous spinal surgery. The group with no prior surgery was called the primary surgery group. Patients who had a previous surgery were put in the revision group.

Reasons or indications for fusion included deformity, instability, and bone or joint disease. Disc collapse or disc pain was also included. Surgeons were given descriptions for each of these classifications.

The spine surgeons’ task was to select the reason for fusion using this classification system. Results of the clinical exam, X-rays, and other studies were used to make the decision. The surgeons' responses were analyzed for consistency.

The authors report the level of agreement among the 19 surgeons was ‘only moderate.' Surgeons were unable to agree on why each patient was chosen for spinal fusion. Decisions are difficult to make because patients often have more than one spinal level involved. Some have X-rays that look worse than the clinical picture and vice versa.

The authors say this classification system isn't reliable for use with all patients. Degeneration at multiple levels makes the decision more difficult. More study is needed to improve the system.
Steven D. Glassman, MD, et al. Lumbar Degenerative Classification Study. In The American Journal of Orthopedics. April 2006. Vol. 35. No. 4. Pp. 175-179.