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Education And Debate

Controversies in Management: Should backache be treated with spinal fusion?

BMJ 1996; 312 doi: (Published 06 January 1996) Cite this as: BMJ 1996;312:38
  1. John P O'Brien, consultant surgeon in spinal disordersa
  1. a 149 Harley Street, London W1N 2DE

    Backache indicates pain originating in the vertebral column (most commonly in the lowest two mobile segments of the lumbar spine). It is felt mainly in the lower back and buttocks, often being referred to the lower limbs. Referred pain in the limb can be confused with radicular pain (sciatica) from nerve root compression.

    Fusion is a non-specific term. It comes from the Latin fundere—to pour or to melt. In the context of the spine, fusion entails welding or stiffening two or more vertebral bodies. Arthrodesis might therefore be a more appropriate word (removing of the articular surfaces and securing bony union1).


    Hippocrates in 380 BC observed spontaneous fusion of the facet joints in a case of spinal tuberculosis. It was nature's attempt to halt the progress of the deformity. Hibbs read the work of Hippocrates, and in 1911 surgically fused the posterior spinal elements in young patients with spinal tuberculosis.2 This successfully prevented subsequent deformity. Later Hodgson and Stock …

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