Lumbar Spinal Fusion (single level)

What it is

Two vertebrae that move abnormally against each other can grind, pinch nerves, and hurt. A fusion stops that movement for good. The surgeon lays bone graft between and alongside the two vertebrae, and over the following months the graft knits with the patient's own bone until the pair behaves as a single block. This code describes the fusion done through the back of the lower spine across one segment — a single level, meaning one pair of vertebrae. Screws and rods are usually added to hold everything still while the bone grows, but that hardware is a separate item on the bill, not part of this code. A fusion done through the abdomen, or one spanning more levels, is coded differently.

Why it is done

• For spondylolisthesis, where one vertebra has slipped forward on the one below it
• For instability left behind by a fracture, an infection, or a tumor
• Alongside surgery to take pressure off nerves, when removing the bone that was compressing them would leave the segment unstable
• For degenerative disc disease or arthritis at one level that has not responded to non-surgical treatment

What to expect

This is major surgery under general anesthesia, and a hospital stay of a few days is typical. Walking starts early, often the day after, and a brace is sometimes used at first. Bending, lifting and twisting are restricted while the graft takes. Formal physical therapy generally begins weeks to a few months out rather than immediately, and the bone is not considered solid for several months. Results vary: fusion reliably stops the motion it is meant to stop, but that does not guarantee the pain goes with it, and surgeons generally say so plainly before agreeing to operate.

Questions worth asking

• Are the screws, rods, cages and any bone-graft substitute included in the hospital's charge, or listed as separate implant lines? Implants are often the biggest component of a fusion bill.
• Will there be an assistant surgeon or a co-surgeon, and does each bill separately?
• Is nerve monitoring being used during the operation? It is frequently provided by an outside company that sends its own bill, and in-network status should be checked in advance.
• What length of stay is expected, and has my plan authorized that many days? Fusions are commonly reviewed for medical necessity before approval.