Since the 1990s the rate of spinal fusion to treat lower back pain has been on the rise. A new prospective clinical study published in the journal Neurosurgery, the official journal of the Congress of Neurological Surgeons, found that lumbar fusions were three times more likely to be effective and obtain better patient outcomes, when guidelines for fusion were followed. The results suggest that when surgeons operate outside of what the evidence based literature suggests, patients may not have significant improvements in their quality of life and could have increased pain or other limitations.