Transpedicle instrumentation in the degenerative spine.

Controversy continues regarding the use of pedicle instrumentation in fusion surgery on the degenerative lumbar spine. Recently, however, published reports are increasingly demonstrative of the positive effect of pedicle fixation on fusion and outcome success in the management of these disorders. Recent developments in surgical technique and implant design have improved operative risk and implant related complications. However, patient selection and demonstration of the underlying pathophysiology of degenerative lumbar motion segment pain remain 2 of the main challenges to clinical practice. The importance of well designed clinical studies are of paramount consequence in the solution of the existing controversies surrounding surgical treatment of the degenerative lumbar spine. Equally significant is the need to establish general and accepted measures of outcome to assess and compare treatment options. Combining study design and accepted outcome assessment will permit the resolution of the remaining controversies. The future of pedicle instrumentation of the degenerative lumbar spine is of necessity tied to the resolution of these remaining points of controversy-only thereafter can the current rate of advances continue.