Lumbar spine surgery is a common intervention for patients with disc herniations, spinal stenosis, spondylolisthesis, and traumatic spinal pathology.1 Among these procedures, lumbar fusion is frequently performed to stabilize the spine and decompress neural elements in order to relieve pain and improve function.1 Despite its widespread use, lumbar fusion carries a risk of long-term complications, most notably lumbar nonunion, or pseudarthrosis, in which the intended osseous fusion between vertebral segments fails to occur.2,3

Lumbar pseudarthrosis is associated with persistent pain, mechanical instability, neurological symptoms, and functional decline, often necessitating revision surgery.2 These revisions are technically demanding and resource-intensive and are associated with prolonged recovery and increased complication rates.3 Consequently, lumbar pseudarthrosis imposes a substantial economic burden on patients and healthcare systems alike.⁴ This article examines the financial impact of lumbar pseudarthrosis and explores whether investment in biologics, higher-cost implants, or surgical strategies aimed at preventing pseudarthrosis may represent a cost-effective approach in the long term.