Indications

· Age 18 – 60 years of age: optimally < 55 years of age.
· Symptomatic degenerative disc disease at a single or double level (L2 to S1 region).
· Degenerative changes proven by objective radiology, CT Scan and / or MRI.
· Origin of pain confirmed to be from the disc with provocative discography.
· Mild or moderate facet joint degenerative changes maybe present, but not significant pain contributor.
· Adjacent segment disease – single level adjacent to previous successful fusion.

Contra-Indications

Patients with

- Osteoporosis
- Listhesis (Degenerative or lytic), or undisplaced lysis
- Instability or significant previous posterior decompression surgery
- Severe facet joint arthrosis
- Fractures
- Tumours
- Infection
- Scoliosis
- Non-contained herniated disc pathology - 1
- Spinal stenosis (See Modifiers below) - 2
- Morbid obesity (BMI > 40)
- Arachnoiditis
- Severe Vascular pathology
- Prior retroperitoneal surgery or irradiation
- Previous unsuccessful attempt at fusion .

Modifiers

1. Can be done in the presence of a contained disc herniation.
2. Foraminal stenosis, may in selected patients be relieved by the use of an intervertebral prosthesis.
3. Patients should be fully informed of complications that may arise from this procedure, and that these might not be easily reversed.

(This protocol was discussed & approved at the AGM of the South African Spine Society: June 16, 2005, Bloemfontein (Last reviewed & amended August 2009)