Lumbar Spinal Fusion and Endplate Osseointegration: ‘Spot Welding’ is No Substitute for Full-Volume Biologic Fusion


The strategy of using only a surface framework to allow bony integration for interbody fusion has become a fashionable topic in spinal surgery forums. Three-dimensionally printed Ti cages have become popular, with the implication that surface ingrowth is all that is necessary to effect an interbody arthrodesis, and that application of bone graft is secondary and potentially of no clinical importance.

At an average total cost of $40,000 for a lumbar spinal fusion1, this idea is certainly attractive to those focused on reducing the time and costs associated with these procedures. However, the best science demonstrates that this is a case of too good to be true.