Although our physicians are trained and experienced in these techniques, a fusion is not a procedure to be taken lightly. The success rate in cervical fusion for disc herniation approaches 95% when patient selection is appropriate, and most of these patients resume normal activities within a few months of their procedure.

In the lumbar spine, however, the success rate is fairly low, and the complication rates clearly seem to outweigh the benefits for most patients. Simple disc herniations that require surgery do not need to be fused in the vast majority of cases. Instability is the commonly accepted indication for fusion; in patients that meet the strict criteria for instability in the lumbar spine, a procedure with or without instrumentation will be discussed.

An inordinate number of lumbar spinal fusions are currently being done in this country, with little agreement on indications and requirements for this procedure. What is known, is that the complication rates and failures in patients chosen with liberal criteria are quite high. Dr. Walpert takes these considerations very seriously and recommends lumbar and cervical fusion only when rigid criteria are met.

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