====== Non instrumented lumbar fusion ======

see The Current Role of Un-Instrumented Lumbar Fusion
((Barzilai O. The Current Role of Un-Instrumented Lumbar Fusion. World
Neurosurg. 2018 May 18. pii: S1878-8750(18)31016-7. doi:
10.1016/j.wneu.2018.05.063. [Epub ahead of print] PubMed PMID: 29783011.
)).

Non-[[instrumented lumbar fusion]] is an accepted technique for the treatment of various spinal degenerative pathologies. 

A meta-analysis found that inclusion of [[fusion]] [[surgery]] with instrumentation provided no benefit as evaluated by patient-reported outcomes in patients with [[lumbar spondylolisthesis]]
((Ye YP, Chen D, Xu H. The comparison of instrumented and non-instrumented
fusion in the treatment of lumbar spondylolisthesis: a meta-analysis. Eur Spine
J. 2014 Sep;23(9):1918-26. doi: 10.1007/s00586-014-3453-1. Epub 2014 Jul 14.
PubMed PMID: 25018032.
)).


In 376 patients, with a mean age of 61.1±standard deviation of 13.54years. The most common presenting symptom was back pain in 344 (91.5%) patients, followed by radiculopathy in 304 (80.9%) patients. The most common pre-operative diagnosis was multi-level spinal stenosis with claudication in 211 (56.1%) patients. At last follow-up, the prevalence of back pain (60.64%; p<0.001) and radiculopathy (57.71%; p<0.001) were significantly lower. The cumulative rate of ASD was 18.35% (69 patients). In total, the rate of re-operation due to non-improvement or worsening of symptoms was 30.59% (115 patients). In this manuscript, we present one of the largest cohorts of patients undergoing in situ fusion for degenerative lumbar spine disease with a median follow-up time of 92 (range 24-154)months. Although the prevalence of both back pain and radiculopathy was significantly reduced at last follow-up, a significant portion of patients still experienced continued symptoms. Notably, while 18.35% of patients developed ASD, 30.6% of patients required re-operation due to recurrent or worsening symptoms during the follow-up period, highlighting the need for additional stabilization techniques
((Santiago-Dieppa D, Bydon M, Xu R, De la Garza-Ramos R, Henry R, Sciubba DM,
Wolinsky JP, Bydon A, Gokaslan ZL, Witham TF. Long-term outcomes after
non-instrumented lumbar arthrodesis. J Clin Neurosci. 2014 May 12. pii:
S0967-5868(14)00099-X. doi: 10.1016/j.jocn.2014.02.010. [Epub ahead of print]
PubMed PMID: 24831342.)).