You might have believed that the surgery would end the pain after managing it for years. However, some people might still suffer from the same symptoms and have had little relief from the surgery.
What if you still suffer from the pain even after months of pain management, rehabilitation and physical therapy? The answer is second spine surgery, and technically doctors would say it as revision spine surgery.
But what is this revision surgery exactly, and if you truly need second back surgery, how to know?
As the name implies, revision surgery is the correction of a previous operation that either failed to relieve symptoms of your initial condition or caused further internal complications as a result of misdiagnosis, surgical error, insufficient fusion, infection, malfunction of the implants or prosthetics, or inadequate recovery following your previous surgery.
There is one aspect of the entire issue which needs close consideration. In even common operations like a micro lumbar discectomy there is always a 5% chance of recurrence and in these situations revision surgery may bring benefit to the patient.
Your spine is a complex body part that can affect the performance of both the skeletal and nervous systems. This means a revision spinal surgery has an increased risk of complications and should be addressed by an experienced spine specialist.
Considering the type of initial spine surgery you have undergone and the symptoms you are experiencing, the spine surgeon will order some diagnostic tests to determine the exact cause of your problem after surgery. Some surgical problems like loose screws and infection at the site might require immediate treatment.
Here are some of the revision spine procedures or second spine surgery:
Revision Discectomy
An initial discectomy involves removing the part of the extruded disc prolapse that caused discomfort. Depending on the situation, times there is a chance of recurrence of the disc rupture. Normally in disc surgery, only the loose portion which has extruded will be removed. Some normal tissue attached to the host tissue will remain. It can get separated and extrude a few weeks to few months after the surgery and this is called recurrent disc prolapse.
If the pain and symptoms persist, a doctor might recommend a revision discectomy that requires more of the vertebra to be removed to relieve pain. A microdiscectomy is a minimally invasive procedure that is commonly used to remove pieces of herniated discs that compress your nerve or spinal cord. If the patient is more anxious then a fusion procedure can be offered as a final solace.
Revision Fusion
Once a fusion surgery is done with bone grafting and implants, the usual outcome is solid fusion with good outcomes. Unfortunately after the index operation sometimes the implants might malfunction and there can be a nonunion and recurrence of the previous symptoms. In such situations, one may need to undergo spinal fusion
After an initial fusion surgery, if your doctors diagnose your postoperative pain as pseudoarthrosis (a lack of proper fusion), they may recommend another fusion called revision fusion surgery.
Fusing bones depends on their natural ability to heal together. However, conditions such as smoking, diabetes, overweight, ageing, poor nutrition, and hardware can have negative effects on the initial fusion process.
In 45-56% of revision surgeries, the reason is pseudoarthrosis and implant failure. So it is very important to strictly follow your doctor’s recovery instructions to lower your risk of revision surgery.
Epiduroscopy
It is inevitable and necessary for scar tissue to form following surgery, but an excessive layer of scarring can attach to surrounding nerves and compress them. An Epiduroscopy is a surgical procedure that involves the removal of excess scar tissue, causing pain and discomfort months after surgery.
A revision procedure such as Epiduroscopy enables the surgeon to view directly into the inflamed area. Then he eliminates the adhesions and scar tissue with a laser and applies local steroids to reduce swelling and detaches the attached nerve from the scar tissue.
The primary advantage of this method is its precision. However, the additional procedure always tends to create additional risks, so a specialist spine surgeon to perform the revision surgery would be a better option and lets you know how to prevent scar tissue.
Foraminoplasty
In revision surgery, a doctor will prefer the least invasive approach possible. Foraminoplasty is one such highly preferred procedure that requires a tiny incision and tiny surgical tools that allow access to only one particular portion of the spine without damaging surrounding tissue.
This approach is mostly preferred during disc herniation, bone spur, and nerve compression based on the severity of your symptoms and the location of the source. Foraminoplasty has a good success rate but it is only indicated in very specific conditions.
Spinal Hardware Removal & Revision
You might experience pain if your body reacts negatively to any implants placed in your previous surgery as a result of an infection. This is because your body may reject the metal implant, the screws become loose etc. During revision surgery, the hardware will be removed, and the infection will be treated with antibiotics.
By nature, surgery is a risky process and may result in complications. The nature of every body is unique, so are each surgery’s outcomes. Therefore, the full range of possible outcomes can be extremely difficult to access.
Revision surgery is a complex surgical procedure and should be handled by a specialist familiar with revision spine surgery. The above-mentioned surgical procedures yield good results. A specialist spine surgeon who is capable of diagnosing and managing your pain is crucial to successful revision surgery.
If you have had spine surgery and still experiencing pain, then contact Dr. Surya Prakash, one of the best revision spine surgery specialists in Hyderabad. He helped thousands of patients with recurring spine problems.
