Spinal fusion surgery

For the treatment of

Mechanical axial low back pain

Commissioning position

This intervention is commissioned if it is undertaken as part of the treatment of:

Serious spinal pathology (e.g. neoplasm, infection or osteoporotic collapse) OR
Scoliosis OR
Sacroiliac joint dysfunction OR
Nerve compression, where a more extensive exposure of the affected neurological structures is required and would otherwise render the spine unstable

Fusion is not otherwise commissioned for the treatment of pain localised to the low back and not present in the lower limbs.

Summary of rationale

Isolated back pain is common, often multifactorial and amenable to multimodal non-operative treatment (e.g. lifestyle modifications, weight loss, analgesia, exercise). By the nature of the description, isolated back pain, a focal site of pathology is often never found. In many cases, symptoms may be underpinned by a centralised pain disorder that exists outside of the spine.

In the absence of a focal structural pathology and concordant mechanical or neurological symptoms, there remains a distinct lack of high-quality evidence to support fusion of the spine as a treatment of isolated back pain. NICE Guideline NG59 established formal, multidisciplinary consensus on the management of isolated back pain, which is implemented through the National Back Pain Pathway. This NICE-endorsed pathway offers all patients timely, evidence-based care for back pain.