Enhancing spinal fusion.

The acquisition of bony fusion is a complex task. Attention paid to the details presented here may improve fusion rates and patient outcomes. We have much to learn. We should focus on the details of the present and on the possibilities of the future to guide our surgical decision-making process. Indeed, "traumatized bone, whether disrupted via an overt act of trauma or via surgical intervention, heals best when bone healing enhancing parameters are optimized." Our problem to date is that we do not precisely know when, and under what loading conditions, such an optimization process occurs. It is certain that pressure and load affect this process, as suggested by Wolff. This has been portrayed here. The measurement of these parameters in vivo in humans should provide insight into the process of bone healing and ultimately lead to our ability to positively affect the healing of bone and, hence, patient outcomes.