SCOLIOSIS REVISION SURGERY

Success Rate for Scoliosis Revision Surgery

The success rate of scoliosis revision surgery varies depending on the specific circumstances of each case. However, with advancements in surgical techniques and postoperative care, the success rate has significantly improved in recent years. Factors that influence the success rate include the severity of the initial deformity, the underlying cause of the revision surgery, and the surgeon’s experience. Success is measured by pain relief, improved alignment, and functional outcomes.

What Percentage of Scoliosis Spine Surgeries Fail?

While scoliosis surgery has a high success rate, complications can occur. These can include:

• Pseudarthrosis: Failure of the bone graft to fuse properly.
• Hardware failure: Loosening, breakage, or migration of implanted hardware.
• Infection: Bacterial infection at the surgical site.
• Neurological injury: Damage to nerves during surgery.
• Progressive deformity: Continued worsening of the spinal curve.

The failure rate for scoliosis surgery varies depending on the complexity of the case, the surgeon’s expertise, and the type of surgical approach used. Studies suggest that approximately 10-20% of scoliosis surgeries may experience complications or fail to achieve optimal results, requiring additional intervention. Common reasons for failure include hardware failure, inadequate correction, infection, or persistent pain.

Adult scoliosis cases often have a higher revision rate compared to pediatric cases due to degenerative changes and greater surgical challenges.

Can You Have Scoliosis Spine Surgery More Than Once?

Scoliosis spine surgery can be performed more than once. Revision surgery is specifically designed for cases where the initial surgery does not achieve the desired outcomes or complications arise. However, multiple surgeries increase complexity and potential risks, so thorough evaluations are critical before proceeding.

Benefits of Having Scoliosis Revision Spine Surgery

• Improved Alignment: Correcting residual or progressive spinal deformities.
• Pain Relief: Alleviating chronic pain caused by hardware issues, nerve impingement, or structural instability.
• Enhanced Mobility: Restoring spinal stability and function.
• Better Quality of Life: Improved physical appearance and reduction of psychological distress associated with deformity.
• Cosmetic improvement: Correcting residual deformity and improving the appearance of the back.

How Does a Patient Prep for Scoliosis Revision Spine Surgery?

Before surgery, patients will undergo a comprehensive evaluation, including imaging studies and consultations with the surgeon. They may need to undergo preoperative tests, such as blood tests and an electrocardiogram

• Comprehensive Evaluation: Imaging studies (X-rays, MRIs, CT scans) and blood tests.
• Medical Clearance: Addressing underlying health conditions like diabetes or osteoporosis.
• Lifestyle Adjustments: Quitting smoking, improving nutrition, and pre-surgical physical therapy to enhance muscle strength.
• Mental Preparation: Counseling or support groups to manage expectations and anxiety.

Best Candidates for Scoliosis Revision Spine Surgery

• Patients with persistent pain or disability despite initial surgery.
• Those with progressive spinal deformities or structural instability.
• Cases of hardware malfunction, infection, or pseudoarthrosis (nonunion of spinal fusion).
• Neurological symptoms
• Significant cosmetic concerns
• Individuals in good general health, capable of tolerating a complex surgery.

What to Expect During Scoliosis Revision Spine Surgery

The specific procedure will depend on the individual case. However, it typically involves:

• Procedure Duration: Typically longer than the initial surgery, often 6-10 hours.
• Techniques Used: Removal/replacement of hardware, correction of deformity, and re-fusion of affected spinal segments.
• Postoperative Care: Intensive monitoring, pain management, and early mobilization.
• Removal of old hardware: Removing any existing screws, rods, or bone grafts.
• Debridement: Cleaning the surgical site to remove any infected or necrotic tissue.
• Bone grafting: Using bone grafts to promote fusion between the vertebrae.
• Hardware implantation: Placing new screws, rods, or other devices to stabilize the spine.

Cervical and Lumbar Fusions: Can They Fail and Be Corrected?

Cervical and lumbar fusions can fail to correct scoliosis due to improper alignment, hardware failure, and infection, or adjacent segment disease. Revision surgery can address these failures by:

• Reinforcing or replacing fusion hardware.
• Extending fusion levels to stabilize adjacent segments.
• Relieving nerve compression or correcting residual deformity.

Challenges and Complexities of Scoliosis Revision Surgery

Revision surgery is more challenging than primary surgery due to:

• Scar Tissue: Increased risk of nerve damage during reentry.
• Anatomical Changes: Deformities or hardware from the initial surgery can complicate access.
• Bone Quality: Poor bone density in adults can hinder successful fusion.
• Extended Operative Time: Increases risks of infection and blood loss.
• Adhesions: Adhesions can form between tissues, making it difficult to separate structures.
• Neurological risk: The risk of nerve injury is higher during revision surgery.

Risks and Complications of Scoliosis Revision Surgery

• Infection or wound healing problems.
• Neurological complications like nerve injury or paralysis.
• Blood clots or excessive blood loss.
• Hardware failure or pseudoarthrosis.
• Persistent pain or limited mobility despite surgery.

Innovative Techniques for Scoliosis Revision Surgery

• Navigation Technology: 3D imaging and computer-assisted surgery for precise hardware placement.
• Minimally Invasive Techniques: Smaller incisions reduce recovery time and complications.
• Biologics: Use of bone graft substitutes to enhance fusion success.

Reducing Risks and Complications After Surgery

• Choosing an experienced surgeon: Selecting a surgeon with extensive experience in scoliosis surgery, particularly revision surgery.
• Following preoperative instructions: Adhering to preoperative guidelines, such as fasting and medication instructions.
• Adhere to Rehabilitation: Commit to physical therapy and follow-up care.
• Maintain a Healthy Lifestyle: Balanced diet, regular exercise, and avoiding smoking.
• Monitor for Symptoms: Early detection of complications like infection or nerve issues can improve outcomes.
• Attending follow-up appointments: Regularly visiting the surgeon for monitoring and evaluation.

Long-Term Outcomes of Scoliosis Revision Surgery

The long-term outcomes of scoliosis revision surgery can vary widely. Many patients experience significant improvement in pain, function, and quality of life. However, some may continue to experience pain or other complications. Long-term follow-up is essential to monitor the patient’s progress and address any issues that may arise.

It’s important to note that the decision to undergo scoliosis revision surgery should be made in consultation with a qualified Scoliosis spine surgeon who performs the surgery just about every week. The surgeon will weigh the potential benefits and risks of the procedure and discuss the patient’s specific circumstances.

• Improved pain management and functionality.
• Stabilized spinal structure and reduced deformity progression.
• Enhanced psychological well-being and overall quality of life.

Causes of Scoliosis Revision Surgery

Scoliosis revision surgery is typically required due to complications, or continued issues following the initial surgery. The most common reasons for revision include:

• Hardware Failure: In cases where rods, screws, or other hardware become loose, break, or shift, surgeons normally recommend revision surgery. In these cases, surgeons may remove or replace the hardware to restore spinal stability.
• Pseudoarthrosis: When a spinal fusion fails to heal or fuse completely, this condition can result in pain and instability.  This necessitates a revision to encourage proper bone fusion.
• Curve Progression: In some cases, the spinal curve may continue to worsen despite initial surgery.  The cause can point to underlying conditions, biological factors, or incomplete correction.
• Infection: If an infection develops around the surgical site or hardware, surgeons may recommend revision surgery.  The spinal surgery will remove infected tissue or hardware and treat the area.
• Chronic Pain: Persistent or worsening pain, particularly if associated with nerve compression or instability, may lead to revision surgery to alleviate symptoms.
• Deformity Recurrence: Over time, even after surgery, the spine may gradually return to a curved position, especially if fusion was incomplete or the original structure wasn’t strong enough to prevent further deformity.

Identifying Symptoms that Indicate the Need for Scoliosis Revision Surgery

Scoliosis revision surgery may occur when complications or new symptoms arise following an initial scoliosis surgery. Recognizing these symptoms early can lead to effective intervention. Here are the primary symptoms that may indicate the need for revision surgery:

Persistent or Worsening Back Pain:

• Chronic pain that doesn’t improve with non-surgical treatments or new, sharp pain at the surgical site, may suggest issues such as hardware failure, incomplete fusion, or nerve compression.

Limited Mobility and Stiffness:

• Difficulty with movement, especially when limiting daily activities or worsening over time, can indicate that the spine isn’t adequately stabilized.  It’s also possible that the initial surgery didn’t provide sufficient correction.

Neurological Symptoms:

• Numbness, tingling, weakness, or pain radiating down the arms or legs may indicate that additional correction or decompression is needed.

Curve Progression or New Deformity:

• If the spine’s curve continues to worsen or a new curvature develops, doctors may recommend revision surgery.  This will extend the fusion or re-stabilize the spine to prevent further deformity.

Visible Changes in Posture or Balance:

• Worsening spinal asymmetry, unlevel shoulders or hips, or a forward-leaning posture can indicate that the spine is unstable.  It can also indicate that the initial spinal fusion did not hold the spine in the desired alignment.

Hardware Complications:

• If the surgical hardware (rods, screws, etc.) becomes loose, breaks, or shifts, patients may feel sharp or localized pain. In some cases, they may even feel the hardware under the skin, indicating a need for revision.

Infection Signs:

• Fever, warmth, swelling, redness, or drainage at the surgical site can signal an infection.  This may necessitate revision surgery to remove infected tissue or hardware and address the infection.

Diagnostic Tests to Verify the Need for Scoliosis Revision Surgery

If these symptoms are present, diagnostic tests are essential to confirm whether scoliosis revision surgery is needed and to determine the appropriate surgical plan. Common diagnostic tests include:

X-rays (Standing and Dynamic Views):

• Standard and specialized X-rays, including lateral, anteroposterior (AP), and side-bending or flexion-extension views, are often the first step in assessing spinal alignment, hardware integrity, and any progression in the curve.
• Dynamic X-rays help in identifying areas of instability, particularly if there’s hardware failure or incomplete fusion.

Computed Tomography (CT) Scans:

• CT scans provide detailed cross-sectional images of the spine, offering a clear view of bone structures. They are highly effective for assessing hardware placement, fusion integrity, and any bone abnormalities that may not appear on an X-ray.
• CT imaging helps in diagnosing pseudoarthrosis (incomplete fusion), which can cause pain and instability if present.

Magnetic Resonance Imaging (MRI):

• MRI can evaluate and examine soft tissues, nerve structures, and spinal cord health. It helps detect issues like nerve compression, spinal cord impingement, or inflammation around the surgical site.
• MRIs are often ordered if a patient exhibits neurological symptoms (e.g., numbness or weakness), as they can reveal compression or scarring affecting the spinal cord or nerve roots.

Bone Scans:

• Bone scans can detect infection, inflammation, or areas of high bone activity. These scans are particularly helpful in cases where hardware-related infection is suspected or if there’s suspicion of areas that haven’t fused correctly.

Electromyography (EMG) and Nerve Conduction Studies:

• If neurological symptoms are present, EMG and nerve conduction tests can determine the cause of nerve damage from compression or other spinal issues. This information helps guide decisions about decompression or other surgical adjustments.

Blood Tests:

• Blood tests can help identify systemic signs of infection or inflammation. Elevated markers (like white blood cell count or C-reactive protein) can indicate an infection at the surgical site or elsewhere in the body, prompting further investigation for revision needs.

Combining Symptoms and Diagnostic Findings for Decision-Making

By assessing a combination of these symptoms and diagnostic test results, spine specialists can determine whether scoliosis revision surgery is appropriate. The results guide the specific approach to revision, such as whether hardware needs adjustment, fusion needs extension, or decompression is necessary. Consulting a specialized scoliosis center, like the Southwest Scoliosis and Spine Institute, ensures that patients benefit from advanced diagnostic tools and experienced surgeons who can accurately interpret test results and recommend the best course of action for revision surgery.

Surgical Procedures to Correct Scoliosis Revision Issues

Revision surgeries are complex and tailored to each patient’s unique spinal structure and the nature of their complications. The surgical approach may vary but typically includes the following options:

• Hardware Replacement or Removal: If the initial hardware has failed, broken, or shifted, doctors will recommend removal and replacement with new, more stable hardware. New screws, rods, or other devices may be inserted to provide stability.
• Spinal Osteotomy: An osteotomy involves cutting and realigning segments of the spine to correct any deformity that may have recurred or progressed since the initial surgery. Surgeons consider this procedure as highly effective in restoring proper spinal alignment.
• Extension of Spinal Fusion: In some cases, the initial fusion area may not have been sufficient to prevent further curvature, so the surgeon extends the fusion to additional vertebrae to provide better stability.
• Decompression Procedures: If there is nerve compression resulting in pain, numbness, or weakness, Surgeons can use decompression techniques (such as a laminectomy) to relieve pressure on the affected nerves.
• Bone Grafting: Revision surgeries often require additional bone grafting to promote fusion, particularly if the initial fusion was incomplete. Bone grafts can use the patient’s bone (autograft) or from a donor (allograft).

Due to the complexities involved in revision surgery, each procedure is highly individualized, often requiring more extensive planning and potentially longer operating times than the initial surgery.

Recovery Period for Scoliosis Revision Surgery

The recovery period after scoliosis revision surgery can vary widely based on the complexity of the procedure, the extent of the revisions, and the patient’s overall health. Here’s a general outline of the recovery stages:

• Hospital Stay: Patients typically remain in the hospital for 5 to 7 days post-surgery, where pain management, wound care, and initial mobility exercises are provided.
• Initial Recovery (6–8 weeks): During this period, patients will gradually regain their strength and mobility. Activities are limited, and most patients are advised to avoid heavy lifting, twisting, and strenuous activities. A back brace may be recommended during this time to provide additional support.
• Physical Therapy (Starts 6–12 weeks post-surgery): Physical therapy is introduced to strengthen the muscles around the spine, improve flexibility, and ensure proper spinal mechanics. Therapy sessions may continue for several months to a year, depending on individual progress.
• Full Recovery (6–12 months): It generally takes about 6 months to a year for patients to fully recover. By this point, most individuals can return to normal activities, though doctors will advise to not undertake high-impact activities.

It is important during recovery for patients to schedule regular follow-ups with the surgeon to monitor bone healing, assess hardware placement, and ensure that the spine maintains proper alignment.

The Role of Physical Therapy in Scoliosis Revision Surgery Recovery

Physical therapy is a critical component of recovery following scoliosis revision surgery for several reasons:

• Restores Mobility: Surgery, especially revision surgery, can leave the back stiff and painful. Physical therapy helps restore movement in a controlled and safe manner, allowing patients to regain mobility without risking further injury.
• Strengthens Core and Back Muscles: By strengthening muscles around the spine, therapy provides additional support to the spinal fusion site, reducing the risk of further complications.
• Improves Balance and Coordination: Revision surgery can alter a patient’s center of gravity. Physical therapy retrains the body to move with the new alignment, helping improve balance and coordination.
• Enhances Long-Term Outcomes: Physical therapy reduces pain, improves function, and helps maintain proper posture, leading to better long-term surgical outcomes and a higher quality of life.

Most physical therapy programs are designed specifically for spinal surgery patients and include both in-clinic sessions and home exercises to maximize recovery progress.

Importance of Choosing an Experienced Scoliosis Spine Surgeon at the Southwest Scoliosis and Spine Institute

Scoliosis revision surgery is complex and requires a high level of surgical expertise and experience. Here’s why choosing the Southwest Scoliosis and Spine Institute is a critical step for patients considering revision surgery:

• Specialized Expertise in Complex Spine Surgery: The Southwest Scoliosis and Spine Institute has a team of Scoliosis Spine Surgeons with advanced training and specialization in complex and revision spinal surgeries. Their expertise minimizes risks and enhances the chances of a successful outcome.
• Comprehensive Diagnostic and Preoperative Planning: The institute uses advanced imaging and diagnostic techniques to precisely understand each patient’s unique anatomy and underlying issues. This allows for customized surgical plans that address each problem with the highest level of precision.
• State-of-the-Art Technology and Techniques: With access to the latest surgical technology, including 3D imaging, minimally invasive options, and computer-guided navigation, the surgeons at Southwest Scoliosis and Spine Institute can perform intricate surgeries with maximum accuracy and reduced complication risks.
• Multidisciplinary Approach: Patients benefit from a team approach that includes spinal surgeons, physical therapists, and pain management specialists. This collaborative model ensures all aspects of the patient’s health and recovery are addressed.
• Dedicated Follow-Up and Rehabilitation Support: Postoperative care and rehabilitation also are important to successful outcomes in scoliosis revision surgery. The institute provides structured follow-up appointments and personalized physical therapy plans to support optimal recovery.

Conclusion

Choosing an experienced Scoliosis Spine Surgeon, particularly at a specialized center like the Southwest Scoliosis and Spine Institute, is vital to achieving the best results from scoliosis revision surgery. With their extensive experience, state-of-the-art resources, and commitment to patient-centered care, the institute is well-equipped to handle the complexities of revision surgery, helping patients regain comfort, mobility, and confidence in their spinal health.
Scoliosis Revision Surgery and the Diagnostic tests to verify that revision surgery was needed