What are the potential long-term complications of lumbar fusion?

Medical Advisory BoardAll articles are reviewed for accuracy by our Medical Advisory Board
Educational purpose only • Exercise caution as content is pending human review
Article Review Status
Submitted
Under Review
Approved

Last updated: September 6, 2025 • View editorial policy

Personalize

Help us tailor your experience

Which best describes you? Your choice helps us use language that's most understandable for you.

Long-Term Complications of Lumbar Fusion

Lumbar fusion surgery can lead to several significant long-term complications, with adjacent segment disease (ASD) being the most common serious complication, occurring in approximately 11.7% of patients within 2-3 years post-surgery.

Major Long-Term Complications

1. Adjacent Segment Disease (ASD)

  • Occurs when segments above or below the fusion develop accelerated degeneration
  • Incidence: 11.7% of patients require reoperation for ASD at a mean follow-up of 28.6 months 1
  • More common at the cranial (upper) adjacent segment than the caudal segment
  • Risk factors:
    • Simultaneous decompression at adjacent segments
    • Preexisting spinal stenosis at cranial adjacent segment 1
    • Preoperative sagittal imbalance
    • High pelvic incidence 2

2. Pseudarthrosis (Failed Fusion)

  • Occurs in up to 2.6% of patients with anterior cervical fusion and discectomy 3
  • Characterized by failure of solid bone formation across the fusion site
  • Risk factors:
    • Poor nutritional status (hypoalbuminemia)
    • Smoking status
    • Diabetes
    • Multi-level fusion

3. Hardware-Related Complications

  • Screw loosening or breakage
  • Rod breakage
  • Cage subsidence or migration
  • May require revision surgery, especially if causing neurological symptoms

4. Sagittal Decompensation

  • Loss of proper spinal alignment after fusion
  • Occurs in patients with preoperative sagittal imbalance and high pelvic incidence 2
  • Associated with complications at distal segments, including pseudarthrosis and implant failure

5. Persistent or Recurrent Pain

  • Despite successful fusion, some patients continue to experience pain
  • May be due to:
    • Inadequate decompression
    • Myofascial pain
    • Altered biomechanics
    • Unaddressed pathology at other levels

6. Reoperation Rates

  • Approximately 18% complication rate for lumbar fusion procedures compared to 7% for non-fusion procedures 3
  • Similar reoperation rates between fusion and non-fusion patients (relative risk 1.1) 3

Nutritional Factors and Complications

Poor nutritional status, particularly hypoalbuminemia, significantly increases risk of:

  • Surgical site infections (SSI)
  • Nonunion/pseudarthrosis
  • Wound complications

Studies show that low preoperative albumin is independently predictive of:

  • Increased risk of SSI (p = 0.009) 3
  • Nonunion (OR 0.028 [95% CI 0.001-0.379], p = 0.015) 3

Economic Impact of Complications

Long-term complications have significant economic consequences:

  • Higher hospital costs for fusion vs. non-fusion procedures
  • Longer hospital stays (7 days vs. 5.1 days) 3
  • Higher complication rates (18% vs. 7%) 3
  • Potential for multiple reoperations

Prevention Strategies

To minimize long-term complications:

  1. Careful patient selection - identify those with risk factors for complications
  2. Optimize nutritional status preoperatively - particularly albumin levels
  3. Restore optimal lumbar lordosis - especially in patients with preoperative sagittal imbalance
  4. Secure lumbosacral fixation - particularly important in patients with high pelvic incidence
  5. Consider fusion alternatives when appropriate

Management of Complications

When complications occur:

  • For ASD: Revision decompression and extension of fusion may be necessary
  • For pseudarthrosis: Revision fusion with possible additional grafting
  • For hardware failure: Removal and/or replacement of instrumentation
  • For persistent pain: Comprehensive evaluation to identify specific cause before intervention

Outcomes After Revision Surgery

Revision surgery for complications can be effective:

  • Significant improvements in back pain (VAS-BP) and disability (ODI) scores after revision for ASD, pseudarthrosis, and same-level recurrent stenosis 4
  • Mental health symptoms may be more refractory to improvement after revision surgery 4

Patients should be counseled that while revision surgery can improve pain and function, outcomes are typically not as favorable as primary procedures, and recovery periods may be longer.

References

3
Guideline

Guideline Directed Topic Overview

Dr.Oracle Medical Advisory Board & Editors, 2025

Related Questions

Are spinal bone autograft (CPT code 20936) and spinal bone allograft (CPT code 20930) and insertion of a biomechanical device (CPT code 22853) medically necessary for a patient with lumbar spondylolisthesis and lumbar radiculopathy?
Is a 2-staged procedure, including L1-5 Oblique Lumbar Interbody Fusion (OLIF) and posterior spinal fusion, with pedicle screw (PS) and cages, medically necessary for a patient with secondary scoliosis, and if so, is inpatient admission medically necessary?
Is there an association between multifidus muscle (musculus multifidus) atrophy and facet joint syndrome occurrence?
Is arthrodesis, posterior, lumbar, posterior non-segmental instrumentation (22630, 22840, 20936), and spinal bone autograft medically necessary for a patient with lumbar stenosis due to adjacent segment disease after fusion procedure?
What is the appropriate management plan for a patient with acute and chronic compression fractures of the lumbar spine, degenerative disc disease, and spondylosis?
What is the success rate of lumbar spinal fusion?
What is the role of activated charcoal in the treatment of acute gastroenteritis?
What test(s) can be done to satisfy regulatory requirements for abnormal hemoglobin results?
What medications should be given in acute gastroenteritis?
How can you confirm an anechoic unilocular pelvic mass is not hemorrhagic?
What is the role of Loperamide (loperamide) in treating acute gastroenteritis?

Professional Medical Disclaimer

This information is intended for healthcare professionals. Any medical decision-making should rely on clinical judgment and independently verified information. The content provided herein does not replace professional discretion and should be considered supplementary to established clinical guidelines. Healthcare providers should verify all information against primary literature and current practice standards before application in patient care. Dr.Oracle assumes no liability for clinical decisions based on this content.

Have a follow-up question?

Our Medical A.I. is used by practicing medical doctors at top research institutions around the world. Ask any follow up question and get world-class guideline-backed answers instantly.

Ask Question