Lumbar fusion surgery aims to stabilize the lower spine and reduce pain, but 15% to 40% of patients still have chronic pain afterward.

Why does this happen? Incomplete nerve decompression is a major reason. If the surgery doesn't fully relieve nerve pressure, pain can persist. Scar tissue around nerves can also cause discomfort.

Adjacent segment degeneration is another issue. When part of the spine is fused, nearby sections bear more stress, leading to wear and tear, new pain, and instability.

An often overlooked cause of pain post-fusion is the sacroiliac (SI) joint. It connects the spine to the pelvis and absorbs extra stress after fusion, potentially causing dysfunction, inflammation, and pain.

Changes in spinal mechanics can strain muscles and ligaments, leading to stiffness and muscle spasms. Sometimes, the fusion may not fully heal, resulting in a condition called nonunion, causing ongoing pain.

Therefore, getting multiple opinions before deciding on surgery is crucial, as lumbar fusion is irreversible. Exploring options such as physical therapy, nerve blocks, SI joint treatments, or minimally invasive procedures can help delay or avoid surgery.

For some, reversible options like spinal cord stimulation (SCS) may offer better pain relief. SCS alters pain signals before they reach the brain and is adjustable, making it a safer alternative to permanent fusion.

Temporary or reversible pain therapies like radiofrequency ablation (RFA), peripheral nerve stimulation (PNS), and regenerative medicine offer relief without permanently altering the spine and can help avoid or delay fusion surgery.

While lumbar fusion can help some, it's not a guaranteed fix. Exploring all options, including reversible therapies and SI joint evaluation, can lead to better, long-term pain relief.