Section 1 of 6
Establish the indication
Make the pain-source and treatment rationale explicit.
Risks and benefits
Intended benefit
The intended outcome is better pain and function after appropriate selection and prior nonoperative care. Posterior studies report improvement, but much of the evidence is uncontrolled. Clinical improvement and CT-confirmed fusion are separate outcomes.
Risks and tradeoffs
Discuss infection, bleeding, persistent pain, malposition, neural injury, failure of fusion and possible revision. Risks and evidence depend on the actual implant and approach; a series of selected failures cannot estimate the overall failure rate.
Make the decision together
Compare further nonoperative care and other appropriate interventions. Name the selected construct, explain the uncertainty in its evidence, and plan follow-up for symptoms, function and structural questions.