SPINE REVISION SURGERY

Questions and Answers.

Surgical revisions can pose challenges that were not present with the primary procedures.  This is because the normal spine anatomy is now altered from the original surgery. As an example, the vascular supply to the spine and surrounding soft tissue may become compromised from previous surgery, putting the patient at risk of not healing. Also, the presence of scar tissue at the surgical site can decrease post-operative functionality even with successful fusion. Following our conservative and measured approach to assessing and addressing patients, we will make a thorough and thoughtful decision on non-operative and operative options for patients with difficult problems.

Corrective Surgery

Often, it’s the lumbar spine that is the affected area and causes the most pain. Your lumbar spine is what helps you stand straight, sit in a car and drive, and walk about the grocery store or a park with your family. Your spine supports your body, so if one section is in pain, the entire spine is not functioning correctly. Then you either don’t participate in activities or you must have assistance, or a walker to help you.

Some conditions or common reasons for a corrective revision surgery:

• Pseudarthrosis
• Proximal Junction Kyphosis (PJK)
• Flatback: watch more about Judy Dorsett’s flatback story
• Problems that arose after the initial surgery
• Kyphosis
• Broken hardware
• A new spine injury or deformity
• Adjacent segment disease (ASD)
• Persistent pain and discomfort – Watch LeRoy Foster’s Video

Common Reasons

Pseudarthrosis, a condition in which the spine does not heal correctly after the initial procedure, refers to the most common reason for revision surgeries.  Moreover, patients also may need revision surgery if they develop a new deformity, a secondary outcome to their primary surgery. Other reasons for revision surgery are as follows:

• Discectomy Laminectomy
• Foraminotomy
• Corpectomy
• Spinal (Lumbar) Fusion
• Spinal Cord Stimulation
• Posterior Cervical Revision Surgery

Demanding Surgeries

“Revisions are technically demanding surgeries,” Dr. Hostin said, “Successful spinal fusion requires extra care in preparing the fusion site to make sure we get good clean bones to work with. Especially in adults, where we may use a bone-inducing protein that revs up the bone cells to grow faster.”

Revision surgeries can take place for almost any healthy patient. Fortunately, we have positive surgical outcomes for healthy patients who are in their 80s. Unfortunately, patients with compromised immune systems or those taking steroids for conditions like rheumatoid arthritis may not heal as effectively as those who have not. Therefore, we spend a lot of time planning the strategy for these surgeries.  Also, every patient goes through a very strict pre-operative regimen to help identify potential complications and health risks beforehand.

Complex Surgeries

“We conduct a large number of complex procedures and each one has made us smarter and wiser for the next one,” Dr. Hostin said. “We are able to take care of these complex patients and perform these surgeries thanks to the help of our team and the “best processes” that we have put in place. Thus, the best processes that we use have been established through research-based medicine and lots of experience.

Our fellowship-trained orthopedic physicians have extensive specialized training, meaning they participated in additional in-depth instruction, to perfect their skills in orthopedic spine treatment and surgery. Furthermore, our physicians are also active in research, collaborating with other physicians, worldwide, to further understand and correct spine conditions. Consequently, there are only a few surgeons in the country who are experienced in performing these complex surgeries.

How to Diagnose your Spine Pain Source?

To diagnose the cause of pain or discomfort, at your first appointment with your spine physician he or she will do a very in-depth study of your case. For that reason, please bring any relevant medical records with you for your physician to review. Particularly, your initial evaluation for the condition you wish treatment for. Along with any spinal surgery notes from your first surgery as this will help identify the surgical site and surgical techniques used by your prior physician. And one of the most important items is your most current imaging reports and CD copies, including X-ray, MRI, CT, and so forth regarding your neck or spine.

At your appointment, if you don’t have a recent X-ray of your spine and/or neck, your physician may ask you to take additional X-rays. Also, we possess the newest technology EOS X-ray imaging machine located in our office. Therefore, you don’t need to make an extra stop to get this done. Finally, we will take some new X-rays while you are here, and your physician can review them right away to help diagnose the problem.

Spinal Fusion

Oftentimes, the revision procedure will involve a spinal fusion to correct a spine deformity. During the procedure, your physician will remove scar tissue.  Then utilize a bone graft to fill any gaps in the spine to fuse the bones together. If any additional herniated discs are present, the doctor will correct those during the surgery as well.