Lumbar Fusion

Lumbar fusion joins 2 or more vertebrae so they heal into one solid unit. The goal is to stabilize a painful or unstable spinal segment and, when needed, decompress pinched nerves.

Indications

Main reasons this surgery is recommended:

• Back and/or leg pain from degenerative spondylolisthesis or segmental instability that persists despite structured non-surgical care.
• Spinal stenosis requiring decompression where the segment is unstable (or expected to become unstable after decompression).
• Recurrent disc herniation with instability or deformity at the same level (selected cases).
• Spinal deformity (adult scoliosis), painful motion segment degeneration, or prior surgery with painful instability (selected cases).
• Fracture, infection, or tumor requiring stabilization (selected cases).

Common reasons to delay or avoid surgery:

• Absolute: active infection (skin, urinary, dental, systemic).
• Relative: uncontrolled diabetes, active nicotine use, severe osteoporosis, poor nutrition, severe uncontrolled cardiopulmonary disease, or inability to follow postoperative restrictions and rehabilitation.

Benefits and alternatives

Benefits:

• Reduced leg pain and improved walking tolerance when nerve compression is treated.
• Reduced mechanical back pain when instability is the main pain driver.
• Improved stability and alignment at the fused level(s).
• Potential reduction in need for repeated injections or urgent care visits for flare-ups (varies).

Alternatives:

• Physical therapy (core stabilization, hip mobility, graded activity, gait training).
• Medications (acetaminophen; NSAIDs if safe; neuropathic pain meds if indicated).
• Image-guided epidural steroid injection or selective nerve root block (symptom control, not structural correction).
• Decompression without fusion (for some stenosis and low-grade spondylolisthesis).
• Motion-preserving options (disc replacement) in carefully selected single-level disease.

Surgical procedure

• General anesthesia; antibiotics are given before incision.
• A decompression may be performed (laminectomy/foraminotomy) to free nerves if stenosis is present.
• The disc space and/or posterior elements are prepared to promote bone healing.
• Metal screws are placed into the vertebrae (pedicle screws) and connected with rods.
• Bone graft (your bone, donor bone, and/or a bone-growth product) is placed to help the bones fuse.
• In many cases an interbody cage/spacer is placed between vertebrae (for example TLIF/PLIF/ALIF/LLIF) to restore height and stability.

Key variants: minimally invasive vs open approach; posterior (most common) vs anterior/lateral approaches; interbody fusion vs posterolateral fusion.

Implant or graft specifics and MRI considerations

• Typical implants: titanium or cobalt-chromium screws/rods; interbody cages (titanium or PEEK) and bone graft.
• Implants are intended to stay permanently; removal is uncommon and usually only for infection, painful hardware, or revision surgery.
• Most modern spine implants are MRI-conditional; MRI is usually possible, but images near the hardware can be distorted by artifact. Inform radiology that you have spine hardware.

Typical anesthesia

• Most commonly general anesthesia.
• Multimodal pain control is typical (local anesthetic at the incision, non-opioid medications, and limited opioids as needed).
• Hospital stay is commonly 1 to 3 nights (longer for multi-level fusions or higher medical risk). Some single-level minimally invasive cases may be outpatient.

Recovery timeline

Protocol varies by levels fused, approach, and surgeon preference.

Risks and complications

Common:

• Pain, muscle spasm, temporary numbness near incision, fatigue, constipation, nausea.
• Temporary increase in back stiffness at the fused level(s).

Less common:

• Dural tear (spinal fluid leak), nerve irritation, wound healing problems.
• Infection, blood clot, or pneumonia (risk varies by approach and medical factors).

Rare but serious:

• Permanent nerve injury (weakness, numbness), bowel/bladder dysfunction, major bleeding (especially with anterior approaches), pulmonary embolism, deep infection requiring repeat surgery.

Patient-specific risk modifiers:

• Higher risk with nicotine use, poorly controlled diabetes, obesity, malnutrition, osteoporosis, chronic steroid use, immunosuppression, and multi-level fusion.

Durability and revision risk

• Fusion is intended to be permanent at the treated level(s), but other segments can wear over time.
• In large long-term studies of surgery for degenerative lumbar stenosis and degenerative spondylolisthesis, about 20% to 25% of patients had another spine operation within about 8 to 10 years (reasons include recurrent stenosis, progression, complications, or new problems).¹
• Adjacent segment disease (new symptoms from levels next to the fusion) is a recognized long-term risk; reported clinical incidence ranges roughly 5% to 30% across studies, depending on definitions and follow-up time.²
• Nonunion (pseudarthrosis) can occur, especially with nicotine use, poor bone quality, diabetes, multi-level fusion, or poor nutrition; it may require revision surgery if painful or unstable.

Practical instructions

• Pain control: multimodal plan (acetaminophen; NSAID only if your surgeon approves; ice/heat for spasm; limited opioid as needed). Avoid alcohol and sedatives with opioids.
• Constipation prevention: hydration, fiber, stool softener, and an osmotic laxative if needed while on opioids.
• Wound care: keep dressing clean/dry; shower timing depends on dressing and closure; avoid soaking until cleared.
• Activity: walk several times daily; avoid bending, lifting, and twisting. Follow lifting limits exactly.
• Smoking/nicotine: stop completely before and after surgery because it increases nonunion and complication risk.
• Driving: do not drive on opioids; drive only when you can sit comfortably, turn safely, and brake quickly (often 2-6 weeks; individualized).
• Return to work (typical ranges): desk work 4-8 weeks; light duty 8-12 weeks; heavy labor often 3-6+ months (sometimes longer for multi-level fusion).
• Travel/flying: avoid long trips early if possible; for unavoidable travel, walk every 1-2 hours, hydrate, and do ankle pumps; follow any prescribed clot-prevention plan.
• Red flags (urgent): fever with worsening back pain, increasing redness/drainage, severe new leg weakness or numbness, loss of bowel/bladder control, chest pain/shortness of breath, new calf swelling/pain, severe headache worse when upright (possible spinal fluid leak).

FAQ

1. How long does the fusion take to heal? Bone healing often takes months; many surgeons treat 3-6 months as a key healing window, with continued maturation up to 12 months.
2. Will my back be stiff forever? The fused level will not move, but many people feel better overall as pain decreases; stiffness is more noticeable with multi-level fusion.
3. When can I shower? Usually within days if the dressing allows; do not soak until your surgeon clears it.
4. When can I drive? When off opioids and you can safely brake and turn; often several weeks.
5. Will I set off metal detectors? Sometimes; policies vary.
6. Can I have an MRI later? Usually yes (MRI-conditional hardware), but images near hardware may be distorted.
7. Do I need PT? Often yes; timing varies. Early focus is walking and safe movement; later focus is core/hip strength and endurance.
8. What symptoms need urgent evaluation? Fever with wound drainage, new leg weakness, bowel/bladder changes, chest pain/shortness of breath, or calf swelling/pain.

Disclaimer: Educational information only. Your surgeon may adjust restrictions and therapy based on your diagnosis, levels fused, bone quality, and overall health.

Bibliography (Vancouver)

1. Abdu WA, Sacks OA, Tosteson ANA, Zhao W, Tosteson TD, Morgan TS, et al. Long-term results of surgery compared with nonoperative treatment for lumbar degenerative spondylolisthesis in the Spine Patient Outcomes Research Trial (SPORT). Spine (Phila Pa 1976). 2018;43(23):1619-1630.
2. Cannizzaro D, Qureshi MA, Mosenthal WP, et al. Lumbar adjacent segment degeneration after spinal fusion: clinical and surgical risk factors. J Neurosurg Spine. 2023;39(4):479-488.
3. Austevoll IM, Hermansen E, Fagerland MW, Brox JI, Solberg T, Storheim K, et al. Decompression with or without fusion in degenerative lumbar spondylolisthesis. N Engl J Med. 2021;385(6):526-538.
4. North American Spine Society. Diagnosis and Treatment of Degenerative Lumbar Spondylolisthesis. Burr Ridge (IL): NASS; 2014 (PDF).
5. Kaiser R, et al. Decompression surgery with or without fusion for spondylolisthesis: a systematic review and meta-analysis of randomised trials. J Neurol Neurosurg Psychiatry. 2023;94(8):657-666.
6. Park P, Garton HJL, Gala VC, Hoff JT, McGillicuddy JE. Adjacent segment disease after lumbar or lumbosacral fusion: review of the literature. Spine (Phila Pa 1976). 2004;29(17):1938-1944.
7. Chun DS, Baker KC, Hsu WK. Lumbar pseudarthrosis. Neurosurg Focus. 2015;39(4):E10.
8. Zhang L, Li EN, Huang YZ, et al. Risk factors for surgical site infection following lumbar spinal surgery: a meta-analysis. Medicine (Baltimore). 2018;97(31):e11885.
9. Gadjradj PS, et al. Decompression alone versus decompression with fusion in degenerative lumbar spondylolisthesis: systematic review and meta-analysis. Eur Spine J. 2023.
10. Durand WM, et al. All-cause 5-year revision rates after surgery for lumbar degenerative spondylolisthesis. 2025.