I had a lumbar fusion using bone chips taken from my own pelvic bone. I’m surprised that I can’t see any scar where they took the bone graft from. Does that seem unusual?

You will have to ask your surgeon about this. It’s possible they used a bone substitute instead of harvesting your own bone for the procedure. It’s also possible to remove bone from the iliac crest for use in the fusion without making a separate incision from the fusion incision. The iliac crest is the area of the pelvic bones where bone graft is taken most often. You can feel this bone when you put your hands just below your waist.

You may be wondering how bone can be harvested using the same incision that is used to perform the fusion? Especially because the iliac crest is out to the side from where the bone being fused in located.

An incision is made in the middle of the spine — that’s called a midline incision. With today’s modern surgical tools, the surgeon can harvest bone from the iliac crest right from there.

The fascia (connective tissue) over the bone has to be cut first. Then the surgeon chisels off the top (periosteal layer of bone. A window is cut into the bone and bone is harvested from inside that window. Once the donor bone is removed, the hole is filled with a special Gel-foam. The window is closed and the fascia sewn back together.

The donor bone is transferred to the fusion site and laid down on either side of the spine. Metal plates and screws (called instrumentation) are used as well to hold everything together until the body has enough time to fill in with bone material.

So depending on how your surgeon did the procedure, you may very well only have one incision showing!