Sixty-nine patients were treated by a simultaneous combined anterior and posterior fusion for disabling low-back pain as directed by discographic pain provocation. They were evaluated independently, with an average follow-up of 2 1/2 years (range, 1.6 to 4.1 years). Fusion rates in excess of 90% were noted in patients who had undergone one- and two-level fusions, whereas the fusion rate for three-level procedures dropped to 77.8%. Acceptable clinical results were seen in approximately 80% of the primary low-back pain and the postlaminectomy patients. Results within the group of patients who had undergone previous fusion procedures were less favorable: two thirds good or fair. The available evidence suggests that this procedure is a valid surgical technique, especially applicable to multilevel lumbar fusions and the postlaminectomy patient. Despite its seemingly radical nature, it can be performed quickly and safely with adequate surgical training.