Arthrodesis is at present the best surgical treatment for the persistently painful degenerative back. However, it increases the morbidity and mortality rate in spine surgery, and the possibility of non-union is always present.
Primary arthrodesis in lumbar-disc surgery increases the percentage of successful results. If only the disc is removed, three times as many failures to obtain relief from pain may be expected as when fusion is also performed11.
In my opinion, the best fusion is the one the surgeon is most skillful in performing, unless some extraordinary circumstance indicates that another type of fusion would be preferable.
One should try to fuse the spine in distraction, if possible, in an attempt to open the neural foramen.
It is wise to limit the arthrodesis to as few interspaces as possible, as it has been established that the non-union rate rises dramatically as the number of interspaces involved increases.