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Revision Surgery

My surgeon told me I need to have revision surgery, does that mean
something went wrong at the first operation?

In most cases revision surgery is not due to an error or mistake of a previous operation. Spinal surgery is a complex field and even the very best and most experienced surgeons do not always get excellent results. Common reasons for revision surgery include such problems as pseudarthrosis (failure to achieve solid fusion) which may be due to poor tissue healing and patient related factors. Another element to consider is that the spine is a living and dynamic structure. Even after apparent successful surgery the function and shape of the spine can deteriorate requiring further surgery to remedy a problem. Revision surgery is a complex field and each patient must be evaluated and treated in a very individual manner to understand what is causing the problem and how best to address it.

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I was operated for a herniated disc 1 year ago and now have
worsening back pain, what does revision surgery involve?

There are a number of problems that can arise long after a disc operation. One the one hand, the disc may herniated again, and therefore cause renewed pain. On the other hand, the problem may be related to instability and gradual loss of normal spinal stability due to previous surgery and loss of proper disc function. Revision surgery may thus involve freeing up the nerves again and possibly stabilizing the spine with a fusion. Each case must be carefully evaluated prior to formulating a treatment plan. MRI with contrast and dynamic x-rays can help clarify the source of trouble.

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After Scoliosis surgery many years ago, I am being
told that revision surgery may be necessary to correct my
spinal alignment, what needs to be done?

The spine is a living and dynamic structure. Scoliosis surgery usually involves stabilizing and correcting only the affected levels of the spine. The non-fused levels of the spine may develop progressive curvature and rarely through the crankshaft phenomenon even the fused spine may deform slowly over time. Additionally, syndromes like the flatback can develop many years after scoliosis surgery.

Revision surgery to correct spinal alignment may involve correcting a new curvature that developed after the previous surgery or correcting a poorly aligned original fusion. The previous instrumentation is usually removed, the spine may then be cut through the fusion (spinal osteotomy), realigned with new instrumentation and fused in proper balance.

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What are the risks of revision surgery compared to first time surgery?

In general the risks of revision surgery are not quite the same as for first time surgery because the goals of the operation are different. In addition to ensuring that the goals of the first surgery are met, the revision procedure often has additional element to deal with (ex. Pseudarthrosis, malalignment …). This type of surgery if frequently quite complex and the risks may be higher than for the first procedure. Tissues often do not heal as well with repeated surgeries and the possibility of infection is greater.

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Is it true that the success rate of revision surgery is less than for
first time surgery?

The success rate of revision surgery is very dependant upon the actual problem at hand. In some instances repeat surgery for the same problem may not be as successful as an operation in a patient who has never had surgery. Part of this is due to the formation of scar tissue after an operation which can make revision surgery more challenging.

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Why is revision surgery more complicated than primary surgery?

Revision surgery can be more complicated because the normal spinal anatomy is altered by the original surgery. It may be more difficult to free nerve structures and place instrumentation if necessary. Additionally, the presence of scar tissue from a previous surgery can make the revision procedure technically more challenging. Finally, in the setting of revision surgery it can be difficult to know exactly what the surgeon encountered during the first procedure and what precise steps were performed during that operation. It should also be noted that revision surgery can involve issues of rebalancing the spine and this is a much more challenging task when portions of the spine have been fused and are no longer mobile. In order to rebalance the spine in such a setting requires significant expertise when osteotomies are necessary.

If your questions are not answered here please feel free to contact us.

I need revision surgery because my spinal fusion did not heal well,
what is done in revision surgery to make sure the bone heals this time?

Revisions surgery for a failed spinal fusion may require a circumferential fusion (often called a 360) and therefore exposure of the front and back of the spine. New bone graft must be brought to the area which is to be fused and previous instrumentation (if placed) is often removed to obtain better stability with new implants. In some cases a bone growth stimulator may be placed (a battery powered device which sends a current to the area in order to enhance the possibility of bone formation).

If your questions are not answered here please feel free to contact us.

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