Acute surgical stabilization and fusion or fracture remodeling in nonoperatively treated fractures often will allow the spinal canal to be restored. In some cases this does not occur and residual dural compression is present. Decompression in such instances can yield significant pain relief and resolution of mild paralysis. There are two significant controversies regarding fusion in the lumbar spine. The outcome measurements used are subjective and have poor validation.
Additional controversy resides in the use of pedicle screws as an adjunct to the fusion technique.
Pedicle screws are bone screws inserted through the pedicle into the vertebral body. Once screws are inserted into the vertebral bodies, they are connected by a rod or plate, providing internal fixation to the spine. This situation combined with a small number of poor outcomes has resulted in discussions on national talk shows and news programs and in advertisements for class action lawsuits. These devices are still under consideration by the FDA, and recent studies under the guidance of the FDA have documented their safety and efficacy in appropriate indications. Although the FDA never tried to regulate surgical practice, the situation raised significant concerns among the medical community.