How do surgeons decide who needs a spinal fusion? I went to see my doctor and he never once mentioned a fusion. My husband went to see the same doctor who advised him to have a fusion.

Right now there isn't a lot of agreement among surgeons about spinal fusion. Studies clearly show fusion is a good option for spondylolisthesis.

Spondylolisthesis is a condition in which a fracture occurs in the vertebrae causing the main body to slip forward over the vertebrae below. Pressure on the spinal cord or spinal nerves occurs. Fusion helps hold the bone in place and prevent any neurologic damage.

Other reasons for fusion are much less clear-cut. Fusion may be considered for deformity from scoliosis (curvature of the spine). Degenerative disc disease is another reason surgeons think about fusion as a possible treatment option.

In a recent study at the Leatherman Spine Center in Kentucky a group of 19 surgeons reviewed 32 cases of lumbar degeneration. A model for choosing reasons for fusion was used by each surgeon. Five different indications were offered. The goal was to see how much agreement there was among surgeons.

The results showed only moderate agreement -- not enough to adopt the classification model for general use in the clinic. More work is needed to find a way to help doctors select patients for fusion based on the same criteria.