The pain was so severe that you agreed to a lumbar fusion. Unfortunately, years later the pain continues. What is a spinal fusion? What are the long-term side effects of spinal fusion? What causes spinal fusion to fail? What complications can occur as a direct result of a lumbar fusion? Is there an effective, natural alternative to spinal fusion? Let’s dig in.
Spinal fusion is a major surgery where one or more spinal bones (vertebrae) are fused together using screws, bolts, and or plates. The hardware may be placed in the front (anterior) or the back (posterior) of the spine. The disc between the spinal bones is often times removed and replaced with bone or a spacer. Spinal fusion can be done in the neck, thoracic, and lumbar regions. This blog will focus exclusively on lumbar fusions. Lumbar fusion is a surgical treatment for patients with ongoing pain low back pain or leg pain that has failed conservative treatment. Lumbar fusion surgery has become increasingly popular. Lumbar fusion rates have increased by 336% from 1996 to 2001 (1).
What are the Long-term Side Effects of Spinal Fusion?
Spinal fusion complications long term can be broken down into two major categories: Failure of the procedure itself (failed fusion) and complications arising as a result of the fusion.
Why would a lumbar fusion fail? There are many reasons for this to occur. The most common causes of a failed lumbar fusion are nonunion, hardware breaking, and hardware becoming loose.
Non-union occurs when the spinal bones that are bolted together fail to fuse or grow together. Rates vary depending upon the specific type of lumbar spinal fusion procedure. For procedures that require more bone, like a posterior fusion, the non-union rates are as high as 26-36% (2,3).
Lumbar fusion involves screws, bolts, and plates that stabilize the spinal bones. There are significant forces placed on the low back and the hardware. Regrettably, as a result of these forces, the hardware can break creating spinal instability and pain. The incidence of hardware failure in one study was an alarming 36% (4). Treatment of hardware failure often requires additional surgery to remove the broken hardware and replace it.
Hardware Becomes Loose
Screws are used in lumbar fusion to stabilize the spine. The same forces that can cause the hardware to break can also cause the screws to become loose. This, in turn, can create spinal instability and pain. Collectively about 1 in 10 patients who have a low back fusion will need a second surgery to fix non-union or hardware failure (5).
Complications from Lumbar Fusion
Among the long-term side effects of spinal fusion, there a number of problems that arise as a direct result of lumbar fusion itself. The two most that you need to know are Adjacent Segment Disease and spinal muscle injury.
Adjacent Segment Disease
The disc is an important shock absorber. Fusion surgery removes this important shock absorber placing additional stress and forces on the discs and facet joints above and below the level of the fusion. This additional force in turn can lead to injury of these facet joints and discs leading to degeneration and arthritis. This is a real problem and with an incidence of 9% (6). This can lead to additional surgeries including fusions. To learn more about this tragic complication please click on the video below.
Spinal Muscle Injury
The spinal muscles provide critical stability and support for the spine. Unfortunately, lumbar fusion significantly compromises the health and integrity of these muscles. This is in turn can lead to spine instability and additional injuries including degeneration and arthritis. VA is a recent patient seen in the clinic who experienced this complication. VA underwent lumbar fusion several years ago for severe low back pain. Unfortunately, after the surgery, the pain never changed. His low back MRI is below and is most significant for the death of the critical low back muscles. The MRI is a cross-section image. On the right, the yellow arrows point to dark healthy spine muscles that were present prior to the surgery. The image on the left is after the surgery. The yellow arrows point to the muscles that were injured and now are dead as a result of the fusion surgery.
A recent study looked at the effects of single-level lumbar fusion on spine muscle health (7). The results are alarming! The low back muscles had gotten 50% smaller and weaker due to surgery.
Is There an Alternative to Spinal Fusion?
Absolutely. At the Centeno-Schultz Clinic, we believe in a comprehensive approach to the treatment of spinal pain. We view and approach the spine as a Functional Spinal Unit. This functional unit includes discs, facet joints, ligaments, fascia, and muscles. These structures work with one another in a highly specialized and dependent manner. Therefore for the best results occur when treating the unit as a whole. This novel, comprehensive approach can help you avoid lumbar fusion and its complications. Treatment options include PRP and your own bone marrow-derived stem cells. PRP is rich in growth factors which can increase blood flow and healing. To better understand how to avoid lumbar fusions by using precisely guided PRP and stem cell injections please click on the video below.
Spinal fusion is a major surgery where one or more of the spinal bones are fused together using screws, bolts, and plates. The long-term side effects of spinal fusion involve non-union, hardware failure, Adjacent Segment Disease, and spinal muscle injury. All can require additional surgery. The best way to avoid these complications is to avoid spinal fusion surgery. The Centeno-Schultz Clinic utilizes a Functional Spinal Unit approach whereby the discs, facet, ligaments, and muscles are all evaluated and treated when appropriate. This approach is a successful, natural alternative to lumbar fusion surgery without the complications outlined above. PRP and stem cells are injected under x-ray and ultrasound guidance to promote healing and reduction in pain. If your low back pain persists despite conservative care know that you have regenerative options. Schedule a Telemedicine consult and learn from a board-certified, fellowship-trained physician what options are available. It’s time to free yourself from the pain and limitation.
1.Deyo RA, Gray DT, Kreuter W, Mirza S, Martin BI. United States trends in lumbar fusion surgery for degenerative conditions. Spine. 2005;30(12):1441-5; discussion 1446-7.
2.Tsutsumimoto T, Shimogata M, Yoshimura Y, Misawa H. Union versus nonunion after posterolateral lumbar fusion: a comparison of long-term surgical outcomes in patients with degenerative lumbar spondylolisthesis. Eur Spine J. 2008;17(8):1107–1112. doi: 10.1007/s00586-008-0695-9
3.Herkowitz HN, Kurz LT. Degenerative lumbar spondylolisthesis with spinal stenosis. A prospective study comparing decompression with decompression and intertransverse process arthrodesis. J Bone Joint Surg Am. 1991 Jul; 73(6):802-8. https://www.ncbi.nlm.nih.gov/pubmed/2071615/
4.Mohi Eldin MM, Ali AM. Lumbar transpedicular implant failure: a clinical and surgical challenge and its radiological assessment. Asian Spine J. 2014;8(3):281-97.
5..Greiner-Perth R, Boehm H, Allam Y, Elsaghir H, Franke J. Reoperation rate after instrumented posterior lumbar interbody fusion: a report on 1680 cases. Spine (Phila Pa 1976). 2004 Nov 15;29(22):2516-20. https://www.ncbi.nlm.nih.gov/pubmed/15543064
6.Okuda S, Yamashita T, Matsumoto T, et al. Adjacent Segment Disease After Posterior Lumbar Interbody Fusion: A Case Series of 1000 Patients. Global Spine J. 2018;8(7):722-7.
7.Ho, S., Kim, S., Ha, S. et al. Paraspinal muscle changes after single-level posterior lumbar fusion: volumetric analyses and literature review. BMC Musculoskelet Disord 21, 73 (2020). https://doi.org/10.1186/s12891-020-3104-0