Spinal surgeries are standard and successful procedures performed by spine surgeons on patients with spinal disorders. Most of the patients undergoing spine surgeries are doing well in the long term. As the field of spine surgery developed over time, most of the patients are undergoing spinal surgeries safely. But a few people, around a very small percentage, may require revision spine surgery or re-do spine surgery depending on the complexity of the patient’s condition.
When Is A Revision Spine Surgery Necessary?
Multiple causes can lead to a revision spine surgery. In one of the studies of over 600 patients who underwent spine surgery, it was found that only 9% of patients required a revision procedure. In our opinion, this is quite high. The surgeons noticed that pseudarthrosis is the most common cause of revision spine surgery.
Typically, after three months from the surgery,most of the symptoms which persist usually will be resolved. When a patient complains of persistent, chronic pain with other symptoms, whether to revise the surgery is a question which every surgeon has to consider. Most of the time, Patient will have good surgical outcome for a few years and then later he can have some issue relating to the pseudarthrosis or junctional area which might benefit with revision surgery/
The other conditions that contribute to revision spine surgery are junctional issues around the surgical site due to non-fused vertebrae as a result of external forces on it; in addition, the discs might become compressed or may slip resulting in disk herniation, degenerative disc disease, and spondylolisthesis, etc. some other conditions like infection, implant failure, deterioration of spine, instability, degeneration of adjacent segments or when failed to achieve a solid fusion.
Evaluating The Symptoms Of Revision Spine Surgery
Chronic pain in the back, neck, radiating down to legs. The pain might persist even after surgery or may appear after several days or weeks following surgery. The pain becomes worse when scar tissue starts to build up in the nerve roots spinal column. In addition to pain and tiredness, few patients might incur the loss of balance medically termed as altered trunk position after spine surgery to correct the deformity.
Some other reasons that lead to revision spine surgery include infection at the site of surgery, curve progression, and implant failure. In another study spine surgeons specifically examined the patients who underwent revision spine surgery, they noticed that the most common reason for revision surgery was infection next to pseudarthrosis( no healing of the spinal bones ) and adjacent segment diseases.
When A Surgery Is Not Required
Fortunately, pain and weakness eventually resolve over time following the treatment. If not, it can be addressed with precautionary steps such as physical therapy, specific exercises. So revision surgery may not be required in all cases.
Oral medications such as NSAIDs(non-steroidal anti-inflammatory drugs) or steroid injections can help to reduce inflammation. Very sparingly, narcotics might be recommended for some patients to provide pain relief.
“In case of minor problems after performing spine surgery, they can be managed by conventional treatment,” Dr Surya Prakash explains. “Only few Patients might require revision surgery eventually, but most of them are managed with the help of non-surgical treatment until a revision is done.” Dr Surya Prakash, the best doctor to perform spine surgery in Hyderabad, says it is difficult to predict when someone will need revision surgery. When ever there has been a repeat injury in a case of previous spine surgery which has threatened the stability of spine, Patients will always benefit with repeat surgery. Always Post operative Infections should be managed aggressively, he adds.
Failed Back Surgery
Failed back surgery is actually a misnomer. Sometimes a patient who is not happy with the primary lumbar or cervical surgery is termed as a failed back patient. The main goals of any spinal surgery are decompression, stabilization and fusion based on the need of the preoperative condition. The decompression surgery helps to relieve the compressed spinal nerves and provide relief from nerve pain caused . When indicated a failed back surgery may involve one or more procedures to address the symptoms or progression of the problem. The treatment recommendations are also based on the patient’s overall health.
Here are a few scenarios that may be considered by a spine surgeon for revision spine surgery:
- Decompression is a surgical procedure that aims to decompress the cramped or pinched spinal nerves. If you suffer from nerve pain even after first back surgery, a surgeon evaluates the condition and suggests a decompressive approach if required to ease the pain. Decompression procedures are of different types and opted based on the problem, which includes Discectomy, Foraminotomy, Laminotomy and laminectomy.
- Stabilization is a process that limits abnormal motion between vertebrae. If the vertebrae in your lumbar spine move out of place, it can lead to nerve impairment. With the help of lumbar spinal fusion, two or more vertebrae are fused. But the vertebrae take some time to heal together, so the surgeon uses screws and rods (spinal implant instrumentation) to provide support until the bones fused. Example: The initial correction and fusion are performed in patients suffering from pseudarthrosis ( non healing of spinal bones ) by a posterior approach (from the back). In revision surgery, additional instrumentation is done through an anterior approach (from the front) to provide successful fusion by eliminating instability in the spine.
- Spine osteotomy is a surgical procedure where the bone is trimmed to change its alignment in order to restore proper alignment. In this process, the bone may be shortened or lengthened.
- Removal or replacement of the instrumentation in patients suffering from pain or infection caused due to implants placed in spine surgery.
- Irrigation and debridement – it is a procedure in which the infected tissue is removed, and antibiotic therapy is performed at the site of infection.
Many other health conditions can lead to revision surgery. Follow the surgeon’s instructions strictly post-surgery to avoid revision procedures.
Conclusion – Impact Of A Revision Back Surgery
Technically, revision spine surgery is more challenging to a spine surgeon and carries more risk compared to primary surgery. Scar tissue would be the major problem. While most of the patients think it’s just related to the surface of the skin, but the muscles, nerves, and connective tissue are enclosed deep in the scar. It results in distorted shape and weakens the supportive structures like the dura around the spinal cord that holds the spinal fluid.
In what we have seen in our practice, revision spine surgery is usually less than two percent. By carefully selecting the patients for surgery, we can reduce the need for revision significantly.
Often, the revision procedure involves the replacement of old implants with new ones, extending the fusion of the spine to a larger portion etc. For more related information consult Dr Surya Prakash, the best spine surgeon in Hyderabad who has vast experience in performing complex revision spine surgeries.