Introduction This review evaluates the clinical outcomes and complications of lumbar spinal fusion procedures for patients with a variety of degenerative disorders.

Methods Patients were evaluated with respect to outcome and complications. Further analysis allowed us to compare results in patients who had spinal instrumentation versus in situ fusion. In addition, our patients who underwent primary lumbar fusion were compared with those who underwent revision surgery. One author performed 148 spinal fusion procedures for degenerative disorders between 1990 and 1995. Outcomes were classified using Odom’s Criteria by the co-author. Patients were analyzed in groups so that we could compare primary versus revision procedures and instrumented versus non-instrumented fusions. The 148 patients ranged in age from 22 to 88, with 86 being female. Diagnostic categories included: instability (3%), stenosis (47%), spondylolisthesis (34%), disc herniation (10%), degenerative scoliosis (9%), and spondylosis (4%). Eighty-one patients had primary procedures; 104 patients were instrumented with pedicle screw systems, 127 patients (86%) were fused using iliac crest autograft.

Results Fifteen percent of primary patients developed complications compared to 24% of revision patients. Twenty-one percent of instrumented patients developed complications compared to 16% of non-instrumented patients. Transition syndrome developed in 13% of patients following spinal instrumentation. Average follow-up was 49.5 months. Seventy percent of primary patients had good/excellent results compared with 69% for the revision patients. Seventy-two percent of instrumented patients had good/excellent results compared to 65% of non-instrumented patients.

Conclusions Our retrospective review suggests that well selected revision surgery patients can have similar outcomes to patients who undergo initial lumbar fusion procedures. Although complications occur more frequently in patients who have revision fusions and/or instrumented fusions, clinical outcomes are similar.