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