What is lumbar fusion?

Lumbar fusion is the surgical joining of two vertebrae in the lumbar spine, or lower back. Your vertebrae are the bones that make up your spine (backbone). Lumbar fusion permanently stops movement between two vertebrae. It is a treatment for a variety of diseases and conditions of your spine.

Most spinal fusions use a bone graft to fuse or join two vertebrae. Your doctor may also use screws, rods or plates to hold your vertebrae in place. Lumbar fusion can potentially help decrease pain and maintain function in a damaged or diseased lumbar spine.

Lumbar fusion is a common, somewhat controversial surgery with serious risks and potential complications. You may have less invasive treatment options. Consider getting a second opinion about all your treatment choices before having a lumbar fusion. 

Types of lumbar fusion

Lumbar fusion procedures generally use bone graft material. This involves placing bone graft material in strips along your vertebrae, in pieces between your vertebrae, or packed into a special cage that goes between your vertebrae. Your body heals the bone around the graft over a period of several months. 

Spinal fusion is not immediate with surgery. It takes time for your body to form enough bone around the graft to permanently fuse your vertebrae.

The types of lumbar fusion procedures include:

  • Allograft fusion uses a piece of cadaver bone for the bone graft. Allografts come from a bone bank. Allograft fusions require only one incision and cause less pain than an autograft fusion. However, bone fusion and healing is less predictable with an allograft.
  • Autograft fusion uses a piece of your own bone for the bone graft. Your doctor will usually take bone from your pelvis. This type of lumbar fusion was the only option available in the past. However, an autograft requires an additional incision, lengthens surgery time, and causes more post-operative pain. 
  • Synthetic, or artificial graft fusion uses synthetic (totally man-made) materials and modified natural bone. Some artificial bone graft materials are used alone and others are combined with an allograft or autograft. 

Other procedures that may be performed

Your doctor may perform other procedures in addition to lumbar fusion. These procedures are usually done first and include:

  • Discectomy is the surgical removal of part or all of a spinal disc. A discectomy treats degenerated, herniated or ruptured spinal discs.
  • Foraminotomy is the widening of the opening where the nerve roots leave the spinal canal. Your doctor may use this procedure when the opening (foramina) is narrowed causing pressure on the spinal nerves.
  • Laminectomy is the removal of a bony area called the lamina. The lamina is the back part of each vertebra of your spine. A laminectomy makes your spinal canal larger. This reduces pressure in your spinal canal and your spinal nerves.

Why is lumbar fusion performed? 

Your doctor may recommend a lumbar fusion to treat certain diseases and conditions of the spine. Your doctor may only consider lumbar fusion if other treatment options with less risk of complications are ineffective. Ask your doctor about all your treatment options and consider getting a second opinion before deciding on a lumbar fusion. 

Your doctor may recommend lumbar fusion for persistent lumbar back pain, hip pain, or leg pain caused by: 

  • Arthritis, which is inflammation of the joints that can also affect the joints between vertebrae in the spine 
  • Congenital back deformities, which are deformities present at birth
  • Degenerative disc disease, a breakdown of the cushioning discs between the vertebrae, which can lead to compression of the spinal cord and nerves
  • Fracture of a vertebra
  • Infections of the spine
  • Scoliosis, an abnormal curvature of the spine
  • Spinal instability due to a loss or deterioration of muscles, ligaments and discs that support the spine
  • Spinal stenosis, which is a narrowing of the spinal column causing pressure on the spinal cord and nerves
  • Spondylolisthesis, which is displacement of one vertebra over the one below it
  • Tumors of the spine