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The literature review focuses on artificial intervertebral fusion. An increasing number of instrumented spinal procedures are performed each year with improved diagnostic and treatment strategies, advanced surgical technologies and optimal anesthetic techniques. One of the most common complications of spinal fusion is nonunion with the high reported incidence. Factors affecting fusion rates in lumbar spine surgery are described. Data from articles and textbooks of the last two decades have been used to reflect the current understanding of the research problem including reports in the earlier literature when appropriate.