Cardiac complication is a leading cause of death in the perioperative period after non-cardiac surgery. The present study retrospectively investigated perioperative cardiac complications after spinal fusion surgery in 901 consecutive adult patients who underwent fusion surgery in the lumbar spine from January 2005 to December 2006. Cardiac complications developed in seven patients (0.8%), four males and three females aged 62 to 75 years (mean 66.6 years), in the perioperative period (myocardial infarction in 6 and angina pectoris in 1). Cardiac complications developed after mini-open transforaminal lumbar interbody fusion in four patients and after anterior lumbar interbody fusion in three. No patient had any symptoms related to cardiac disease before surgery. Common features were age over 60 years, a medical history of hypertension and/or diabetes mellitus, and presence of calcified atherosclerosis of the abdominal aorta and/or common iliac arteries. Five patients improved after conservative medical treatment in an intensive care unit. Percutaneous transluminal coronary angioplasty was performed in one patient and coronary artery bypass graft surgery in one. The possibility of perioperative cardiac complications should be considered before lumbar fusion surgery, especially in elderly patients with hypertension and/or diabetes mellitus, and calcified atherosclerosis of the abdominal aorta and/or common iliac arteries.