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To examine whether lumbar disc herniation with massive extrusion and/or segmental instability can be an indicator for spinal fusion or not, by comparing the outcome of posterior lumbar interbody fusion (PLIF) and discectomy alone.One hundred seventy-four patients with PLIF and 177 patients with discectomy were retrospectively analyzed. We hypothesized two criteria for fusion: massive herniation and segmental instability. The patients were divided into four groups according to our original criteria: group F-F (n=96) consisted of the patients who fulfilled the criteria for fusion and underwent PLIF; group nF-F (n=78) consisted of those who did not fulfill the criteria but had PLIF; group F-nF (n=30) consisted of those who fulfilled the criteria but underwent discectomy; group nF-nF (n=147) comprised those who did not fulfill the criteria and underwent discectomy. Each patient was evaluated clinically and radiologically at 5 years after operation.Groups F-F and nF-F had significantly superior results on low back pain compared with group F-nF (F-F vs F-nF, P<0.05; nF-F vs F-nF, P<0.01). The frequency of additional operation at the involved level was significantly higher in group F-nF (10.0%) than in group F-F (2.0%) (P<0.05). Postoperative instability of the adjacent segment developed in 15 cases (8.6%) in groups F-F and nF-F and in 3 cases (1.7%) in groups F-nF and nF-nF (P<0.01).Lumbar disc herniation with massive herniation or segmental instability can be well treated with PLIF.