Lumbar Fusion: Is It The Right Choice For Your Back Pain?

Medically Reviewed By:

Dr. Chaz Fausel, MD

Dr. Chaz Fausel is a Denver-based interventional orthopedics specialist and Regenexx educator, trained at Emory and the Centeno-Schultz Clinic.

The lumbar spine, located in the lower back between the rib cage and pelvis, supports body weight and enables movement. Pain in this region can limit mobility, disrupt sleep, and interfere with daily activities. Chronic lumbar pain often stems from a range of underlying conditions, prompting individuals to seek lasting relief. 

Surgeons commonly recommend lumbar fusion surgery to address these lower back issues. However, emerging research challenges whether this procedure improves outcomes for back pain. Understanding the benefits, limitations, and potential alternatives to lumbar fusion is essential in making informed decisions about back pain relief.

What Is Lumbar Fusion Surgery?

Lumbar fusion surgery aims to stabilize the lower spine and reduce pain caused by movement between affected vertebrae. By fusing vertebrae, the surgery seeks to strengthen the spine’s structure and limit motion that may trigger pain. Many patients pursue lumbar fusion when other treatments fail to relieve persistent lower back pain linked to structural spine problems.

How Lumbar Fusion Works

Surgeons secure the targeted vertebrae using hardware, typically screws and rods, to hold them in place. They may also insert spacers or cages filled with bone graft material between vertebrae to maintain alignment and encourage bone growth.

The hardware stabilizes the spine during healing, allowing the bone graft material to fuse the vertebrae into a single, solid structure over time. This fusion reduces motion between the vertebrae, which can help alleviate pain in the lumbar region.

Key Benefits Of Lumbar Fusion

Lumbar fusion can offer potential benefits for individuals with chronic back pain or spinal instability. By permanently joining affected vertebrae, this procedure addresses both the pain and structural issues associated with various spinal conditions. Below are some primary benefits of lumbar fusion surgery:

• Stabilizing the spine: Lumbar fusion stabilizes weakened or unstable vertebrae, reducing excessive movement and providing a solid support structure.

• Reducing chronic back pain: By addressing spinal instability, lumbar fusion may help reduce chronic discomfort in some patients.

• Correcting spinal deformities: Fusion can improve alignment in conditions like scoliosis or spondylolisthesis, supporting better posture and reducing related pain.

• Improving spinal function: With enhanced stability, the spine may support improved movement and physical capability, leading to greater overall function.

• Preventing further vertebral degeneration: By limiting movement in affected areas, fusion can reduce wear on surrounding vertebrae, potentially slowing further degeneration.

When Is Lumbar Fusion Recommended?

Lumbar fusion surgery is often considered when certain spinal conditions cause persistent pain or instability that does not respond to non-surgical treatments. This procedure is intended to provide stability and relieve pain by limiting movement between the affected vertebrae. 

Below are some of the conditions commonly treated with lumbar fusion, each affecting spinal stability in unique ways:

• Degenerative Disc Disease: Spinal discs can deteriorate over time, leading to pain and reduced flexibility, often contributing to spinal instability.
  
• Spinal Instability: Excessive movement between vertebrae can lead to pain and challenges with maintaining proper spinal alignment and stability.
  
• Spondylolisthesis: A condition where one vertebra slips forward over another, potentially compressing nerves and causing pain in the lower back or legs.
  
• Spinal Fractures: Fractures in the vertebrae, resulting from trauma or osteoporosis, can lead to pain and instability, often affecting movement.
  
• Tumors Affecting The Spine: Tumors in or near the spine may weaken vertebrae, resulting in pain and spinal instability.
  
• Chronic Lower Back Pain: Ongoing lower back pain can interfere with daily activities and significantly affect mobility and quality of life.

• Herniated Disc: A herniated disc occurs when the soft inner portion of a spinal disc pushes through its outer layer, potentially compressing nearby nerves. Depending on the affected area, this may cause pain, numbness, tingling, or weakness in the back, neck, or limbs. Read More About Herniated Disc.

Risks And Complications Of Lumbar Fusion

While lumbar fusion is a common approach for treating severe back pain and spinal instability, patients should be aware of potential risks and alternative options.

For example, lumbar fusion procedures often involve hardware such as screws and rods. However, where one-level fusions were once the standard, some surgeons now perform extensive multi-level fusions, using larger hardware that spans multiple vertebrae and causes significant tissue damage.

Additionally, recent research raises questions about the effectiveness of lumbar fusion, with several studies showing it may not provide better outcomes than less invasive options:

• For patients with low-back stenosis (arthritis pressing on nerves), lumbar fusion was found to be no more effective than decompression surgery, which removes arthritic bone spurs pressing on the nerves.
  
• A randomized controlled trial for the same type of stenosis patients revealed that lumbar fusion was no more successful than physical therapy in relieving symptoms.
  
• Ten to fifteen years after undergoing fusion, many patients reported experiencing similar pain levels as they had before the surgery.
  
• Another study showed that lumbar fusion provided no greater benefit than physical therapy, further calling into question the procedure’s effectiveness.

One complication associated with lumbar fusion is adjacent segment disease (ASD), which can occur when increased stress on spinal segments next to the fusion site causes degeneration over time. ASD may lead to additional pain and, in some cases, further intervention. For more information on ASD, see the video below:

These studies demonstrate the side effects and complications associated with fusion:

• Adding a fusion increases the side effects by 60–90%.1:59
• The number of patients who need a second fusion increases with time.
  Fusion causes hip-replacement prostheses to wear out more quickly.

How Fusion Surgery Is Sold vs. What the Research Shows

From the high markup on surgical hardware to the lucrative insurance reimbursements, the business side of fusion surgery has increasingly influenced its widespread use. Additionally, some patients report being advised that without fusion surgery, they could face severe, irreversible outcomes. This creates the impression that fusion surgery is their only choice.

However, recent studies indicate that lumbar fusion may not provide significant advantages over less invasive treatments. In one study conducted several years post-treatment, patients treated with physical therapy alone reported similar outcomes to those who had undergone fusion surgery. These findings challenge the idea that fusion is the only effective path to recovery.

A recent Swiss study focused on patients with spinal stenosis and degenerative spondylolisthesis—a condition where one vertebra slips forward over another. Participants received either decompression surgery alone or decompression with added fusion. Results aligned with other studies, showing that fusion did not enhance patient outcomes. 

This expanding body of evidence suggests that lumbar fusion may not always provide additional benefits over other treatments, such as physical therapy or decompression alone. Patients must be fully informed of all available options before making a decision.

Are There Some People Who Really Need a Fusion?

Lumbar fusion is necessary in a small number of cases, typically when severe trauma has compromised spinal integrity and demands surgical stabilization. In most situations, however, non-fusion treatments provide effective relief, allowing patients to manage their conditions without resorting to this invasive procedure.

Recently, a patient presented with chronic neck pain following an initial C3–C4 fusion performed in the 1990s. Over time, the fusion hardware had loosened, with a possible infection leading to a recent, extensive C3 to T1 fusion. This additional fusion spanned nearly the entire cervical spine and required both front and back incisions.

This procedure left a substantial scar and involved significant loss of neck muscle tissue due to the large implants, which required extensive tissue disruption. Cases like this illustrate the long-term physical impact of fusion procedures. 

As discussed earlier, research increasingly shows that fusion may add risks without significantly improving outcomes over less invasive treatments. Careful evaluation of alternative approaches remains essential to provide sustainable and effective patient care.

Alternatives To Lumbar Fusion Surgery

For individuals exploring alternatives to lumbar fusion, both non-surgical and less invasive surgical options may relieve back pain and support spinal health. Below are some common surgical and non-surgical options:

• Physical Therapy: Targeted exercises help strengthen and stabilize the spine, reducing pain and enhancing mobility.

• Medications: Anti-inflammatory medications and muscle relaxants can offer temporary pain relief without surgery.

• Steroid Injections: Injections near affected nerves can reduce inflammation and relieve pain.

• Nerve Ablation: Techniques like radiofrequency ablation interrupt pain signals by targeting specific spinal nerves.

• Artificial Disc Replacement: For some cases, disc replacement may preserve spinal mobility while addressing disc degeneration.
• Interventional Orthobiologic Procedures: Physicians in the licensed Regenexx network offer interventional orthobiologic procedures that use Regenexx lab-processed proprietary injectates (platelet-rich plasma and bone-marrow concentrate) to support the body’s natural healing process.

Medically Reviewed By:

Dr. Chaz Fausel, MD

Dr. Chaz Fausel is a Denver-based interventional orthopedics specialist and Regenexx educator, trained at Emory and the Centeno-Schultz Clinic.