SPINE REVISION SURGERY

Questions and Answers.

Understanding Failed Back Surgery Syndrome (FBSS)

Failed Back Surgery Syndrome (FBSS) is a term used to describe a situation where initial surgical intervention for a neck or spine condition does not yield the desired results. In some cases, the surgery may have been performed years ago, and the natural progression of a spine condition, such as scoliosis, necessitates further intervention.

Our institute frequently receives referrals from healthcare providers around the world who trust us with their most challenging cases. With a wealth of experience, we have evaluated over 100,000 patients and successfully completed more than 116,000 spine surgeries. Our commitment to excellence has made us a leading destination for spine revision surgery.

Why Patients Choose the Southwest Scoliosis and Spine Institute for Spine Revision Surgery

Patients often seek our expertise after experiencing unsuccessful attempts to alleviate chronic pain or progressive symptoms. For instance, individuals may arrive at our clinic following fusion surgery that did not heal properly. An exam indicating “non-union” means that the vertebrae did not fuse correctly, resulting in persistent pain. Additionally, some patients encounter issues with loose or broken hardware from their previous surgeries, causing ongoing discomfort.

Many of our patients spend years in pain, longing for a physician with the specialized skills to perform an additional surgical procedure to restore their quality of life. We often hear them express regret about not having found us sooner, realizing how much life they missed due to their suffering.

Surgical revisions can present unique challenges that were not encountered during the initial procedures. The normal anatomy of the spine may be altered from previous surgeries, complicating the revision process. For example, vascular supply to the spine and surrounding soft tissues can become compromised, increasing the risk of poor healing. Scar tissue formation at the surgical site can also hinder postoperative functionality, even if the fusion is successful. Or sometimes, imbalance needs to be address. We have experience in all of these areas and have the team to help you get your life back.

What Makes Spine Revision Surgery Beneficial?

Spine Revision surgery addresses several critical issues that may arise after an initial spinal procedure. One of its primary goals is to eliminate scar tissue that might have developed near your surgical site. This build-up can lead to pinched spinal nerves, causing sharp pain in your legs, back, or neck.

Additionally, revision surgery is often necessary for treating a previously repaired herniated disc if it has suffered another herniation. Disc herniation, where the disc’s jelly-like center pushes through its outer layer, can result in weakness, numbness, and pain in a limb.

Moreover, revision surgery can rectify complications such as spinal infections or hardware failures. Spine hardware, including rods, plates, and screws, can break, loosen, or become misplaced. This might occur due to improper positioning or instability in certain spinal areas.

To address these issues, a surgeon may perform a variety of actions:

• Replace broken hardware
• Reposition loosened hardware pieces
• Tighten any loosened parts

Beyond hardware adjustments, the surgeon will also address any nerve or tissue damage caused by these complications. By tackling these diverse challenges, spine revision surgery offers a path to relief and a renewed quality of life, making it a crucial option for those experiencing these persistent issues.

Complex Surgeries and Specialized Training

The Southwest Scoliosis and Spine Institute is uniquely equipped to handle complex spine surgeries, leveraging years of experience and specialized training. Our fellowship-trained orthopedic surgeons are deeply committed to continued research and collaboration, working with specialists globally to refine treatments for complex spine conditions. “Every case teaches us something new,” Dr. Hostin explains. Our established protocols and best practices, founded on research-based medicine and extensive clinical experience, empower us to handle even the most intricate cases.

Our expert physicians are also engaged in ongoing research, collaborating with leading physicians globally to enhance understanding and treatment options for spine conditions. This commitment to education and innovation sets us apart, with only a handful of surgeons in the country possessing the specialized skills required for these complex surgeries.

“Revisions are technically demanding surgeries,” says Dr. Hostin. “Successful spinal fusion requires meticulous preparation of the fusion site to ensure that we have a clean bone to work with.”

Our experienced team is adept at performing revision surgeries on healthy patients, including those in their 80s. However, patients with compromised immune systems or those on long-term steroid treatments may face more challenges in healing. We prioritize thorough preoperative evaluations to identify potential complications and health risks, ensuring a well-planned surgical strategy.

Common Conditions Requiring Spine Revision Surgery

The lumbar spine is often the most affected area, leading to significant pain that disrupts everyday activities. The lumbar region is crucial for maintaining posture, enabling movement, and supporting essential daily functions.

Here are some common conditions that may necessitate corrective revision surgery:

• Pseudarthrosis: A condition where the spine fails to heal properly after initial surgery.
• Proximal Junction Kyphosis (PJK): An abnormal curvature of the spine that can occur after fusion surgery.
• Flatback Syndrome: A deformity that may develop after spinal fusion, resulting in a loss of normal lumbar lordosis. – Judy Dorsett’s flatback story
• Kyphosis: An excessive outward curvature of the spine, leading to a hunchback appearance.
• Broken Hardware: Complications resulting from loose or broken surgical implants.
• Adjacent Segment Disease (ASD): Degeneration of spinal segments adjacent to a previous fusion site.
• Persistent Pain and Discomfort: Ongoing pain that has not improved after initial surgery. – Watch LeRoy Foster’s Video

Diagnosing 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. 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. 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 have the newest technology, an 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 your pain source.

Find Relief with Our Spine Revision Experts

If you are struggling with persistent pain after a previous spine surgery or have been diagnosed with a condition that may require revision surgery, the team at Southwest Scoliosis and Spine Institute is here to help. Our board-certified, fellowship-trained specialists are committed to providing you with the highest quality of care, utilizing the latest techniques and research to achieve the best possible outcomes.

Don’t let unresolved pain dictate your life. Contact us today to schedule a consultation and take the first step towards finding relief and reclaiming your quality of life.

Surgical revisions can pose challenges that were not present with the primary procedures.  This is because the normal spine anatomy is altered from the original surgery. For 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.

Conservative Treatments to Consider Before Spine Revision Surgery

Before opting for spine Revision surgery, it’s important to explore various conservative treatments that might alleviate pain and improve your condition. Here’s a comprehensive list of non-surgical options to consider:

• Physical Therapy: Engaging in guided exercises can strengthen muscles around the spine, improve flexibility, and reduce pain.
• Steroid Injections: These can help reduce inflammation and provide temporary relief from pain.
• Massage Therapy: Regular massages may help ease muscle tension and improve circulation in the affected area.
• Acupuncture: This traditional Chinese practice involves inserting thin needles into specific points on the body to relieve pain.
• Anti-inflammatory Medications: Over-the-counter or prescription medications can help manage pain and swelling.

Each of these methods may provide relief for different individuals, and it’s often beneficial to combine several approaches for optimal results. Always consult with a healthcare professional to tailor the treatment plan to your specific needs.

Understanding the Risks of Spine Revision Surgery with a Heart Condition

Spine Revision surgery can be a complex procedure, and for individuals with heart conditions, it poses additional risks. Here’s what you need to know:

• Increased Cardiac Stress: Surgery, even when minimally invasive, can place increased stress on the heart. For those with compromised cardiac health, this may lead to complications during or after the procedure.
• Anesthesia Concerns: The use of anesthesia can affect heart function. It’s crucial to evaluate how your heart condition might react to both the anesthesia and the physiological changes during surgery.
• Risk of Blood Clots: The chances of developing blood clots increase during any surgery. For heart patients, this risk requires careful monitoring as it can lead to serious cardiovascular complications.
• Recovery Challenges: Post-operative recovery might be more demanding for individuals with heart issues. The body needs to heal while managing heart health, which can be a challenging balance.
• Potential for Exacerbated Symptoms: The stress of surgery might worsen existing heart symptoms or contribute to new cardiac issues, such as arrhythmia or hypertension.

Before proceeding with spine revision surgery, it’s imperative to consult with both a cardiologist and your surgical team. They can work together to evaluate risks, tailor a surgical approach, and ensure that safety measures are in place to protect your heart health.

Revision 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.

Surgical Procedures

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

Spinal fusion is often a core component of spine revision surgery. During fusion, the surgeon removes scar tissue and uses a bone graft to bridge gaps in the spine, allowing bones to heal together and restore spinal stability. If there are additional herniated discs, our team can address those as well. 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.

Fusion is designed to create a stable spinal structure that minimizes pain and supports long-term mobility. The process is complex, but with expert care, you can achieve better outcomes and renewed quality of life.

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.

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 can 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.

Ideal Candidates for Spine Revision Surgery

When considering spine revision surgery, the best candidates are those who have received a clear diagnosis from spinal surgeons. These diagnoses are crucial to ensure the surgery is necessary and likely to benefit the patient.

Additionally, spine revision surgery is often appropriate for individuals who have not found relief through conservative treatments. These treatments include:

• Steroid injections
• Massage therapy
• Acupuncture
• Physical therapy
• Anti-inflammatory medication

Patients who have explored these options without success may find revision surgery to be the next viable step. It’s important to consult with healthcare providers to determine if surgery is the right choice based on individual health conditions and previous treatment outcomes.”

“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.”

To ensure the best outcomes, it’s crucial to prepare meticulously for your spine revision surgery. Here’s how you can contribute to a smoother procedure and recovery:

• Avoid Tobacco: Refrain from using tobacco for at least 1.5 months before your surgery. Nicotine can constrict blood vessels, reducing blood flow to the surgical site and potentially delaying healing.
• Nutritional Focus: Maintain a balanced diet to keep your body in optimal shape. Proper nutrition is essential for a faster recovery process.
• Limit Alcohol: Steer clear of alcohol during the week leading up to your surgery. This precaution helps minimize bleeding risks during and after the procedure.
• Medication Management: Your doctor might recommend discontinuing certain medications to decrease bleeding risks. These often include:
  • Blood thinners
  • Supplements
  • Anti-inflammatory medicines like ibuprofen

By following these guidelines, you can significantly contribute to the success of your surgery and facilitate a quicker recovery.

Postoperative Care and Recovery

Recovery from spine revision surgery varies depending on the complexity of the procedure and the patient’s overall health. Our team emphasizes the importance of following postoperative care instructions, including physical therapy and rehabilitation, to maximize healing and restore function.

During your recovery, we will monitor your progress closely, adjusting your treatment plan as needed to ensure optimal outcomes. Our goal is to help you regain your strength, mobility, and quality of life as quickly and safely as possible.

What Is the Recovery Time After Spine Revision Surgery?

Recovery from spine revision surgery can vary based on several factors, including the complexity of the procedure and the individual’s overall health. Here’s a detailed breakdown of what to expect during the recovery process:

Initial Recovery Phase

• Immediate Post-Surgery: Some patients may find themselves capable of gentle movements, like walking, shortly after the procedure. However, each individual’s situation can differ.
• First Few Weeks: In many cases, patients may be advised to rest extensively, limiting certain activities to protect the spine, which is particularly sensitive after another surgery.

Intermediate Recovery Phase

• Returning to Work: Depending on your job and how your recovery progresses, you might get the green light to return to work as early as two weeks post-surgery. It’s crucial to avoid any strenuous activities and consult your healthcare provider before making this decision.

Full Recovery

• Three-Month Mark: Most individuals do not feel ready to return to full, normal activities until approximately three months after surgery. This includes resuming intense physical activities or engaging in exercise, which should be discussed with a medical professional.

Long-Term Considerations

• Ongoing Care: It’s essential to attend all follow-up appointments and adhere to personalized recovery plans to ensure optimal healing, minimize discomfort, and prevent complications.

Patience and prudent self-care are keys to a successful recovery. Always follow your surgeon’s specific guidelines tailored to your individual case. Use this general framework as a guide, and remember that recovery times can vary significantly from one patient to another.

Why Patients Choose the Southwest Scoliosis and Spine Institute for Spine Revision Surgery

The reason is pretty simple.  It’s simply because the Team at the Southwest Scoliosis and Spine Institute is led by Dr. Richard Hostin.  He is recognized for his skill and knowledge of the spine.  Fellow doctors refer to him as the Expert. That’s why patients come to him for medical treatment — they want the best.

 ____________________

Footnote

The National Library of Medicine:  Spinal Revision Surgery