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A review of lumbar spinal instrumentation: evidence and controversy
  1. Maya A Babu1,
  2. Jean-Valery C Coumans2,
  3. Bob S Carter3,
  4. William R Taylor3,
  5. Ekkehard M Kasper4,
  6. Ben Z Roitberg5,
  7. William E Krauss1,
  8. Clark C Chen4
  1. 1Department of Neurologic Surgery, The Mayo Clinic, Rochester, Minnesota, USA
  2. 2Department of Neurosurgery, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
  3. 3Division of Neurosurgery, University of California, San Diego, California, USA
  4. 4Department of Neurosurgery, Beth Israel Deaconess Hospital, Harvard Medical School, Boston, Massachusetts, USA
  5. 5Section of Neurosurgery, The University of Chicago, Chicago, Illinois, USA
  1. Correspondence to Dr Clark C Chen, Department of Neurosurgery, Beth Israel Deaconess Hospital/Harvard Medical School, Dana-Farber Cancer Institute, Jimmy Fund 620A, 44 Binney Street, Boston, MA 02115-6084, USA; cchen1{at}


Disability secondary to disorders of the spine is a significant problem worldwide. In the USA, there has been a recent surge in the costs associated with caring for spinal pathology; from 1997 to 2005, there was a growth of 65% in healthcare expenditures on spinal disease, totalling $86 billion in 2005. Increasingly, there has been media and public scrutiny over the rapid rise in the volume of procedures with spinal instrumentation; some have suggested that this rise has been fuelled by non-medical drivers such as the financial incentives involved with the use of instrumentation; others suggest that innovation in spine technology and devices has led to improved options for the treatment of spine pathology.In this context, we conducted a review of the literature to assess the use of instrumentation in lumbar procedures and its relationship to successful fusion and patient outcome. Our review suggests that there is data supporting the thesis that lumbar instrumentation improves rates of fusion. However, there is no consistent correlation between increased rates of fusion and improved patient outcomes.

  • Spinal instrumentation
  • health economics
  • health policy and practice
  • neurosurgery
  • systematic reviews

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  • Competing interests None.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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