Southwest Scoliosis Institute Revision Surgery
Shawn Coker had multiple spine fusion surgeries, and while he says they accomplished what they were supposed to do at the time, his condition continued to deteriorate – causing him pain and forcing him to lean forward constantly.
This made it difficult for Shawn, who had always been an active person, to walk for any kind of distance and do things he loved, like traveling. After exhausting every possible option, he came to Southwest Scoliosis Institute where he met with Dr. Hostin, who recommended revision surgery to correct the problem.
Recovery went much quicker than he expected, and within two weeks he was walking around better than before – and without pain!
What is Revision Spine Surgery?
Revision spine surgery is a procedure to repair or readdress pain and the effects of nerve damage, such as numbness and tingling in the extremities, as well as conditions like spinal instability or herniated discs following previous spine surgery.
Usually, within about three months after spine surgery, any pain or other symptoms should be gone. However, in some cases (around 10-40%), an initial procedure might not produce the desired benefits and results. This is often referred to as failed back surgery syndrome (FBS or FBSS) or post-laminectomy syndrome, and when this happens, doctors may recommend revision spine surgery.
What causes Failed Back Surgery Syndrome or FBS?
Despite the name, Failed Back Surgery Syndrome isn’t really a syndrome at all, but the presence of chronic issues after one or more back surgeries. There are a variety of causes, including certain disorders and diseases that can inhibit healing and may increase the risk of experiencing FBS, such as:
- Autoimmune disorders
- Peripheral artery disease
Smokers are also at higher risk, as cigarette smoking (and nicotine use in general) has been proven to inhibit the healing process and impair a patient’s ability to recover from spine surgery successfully. This is because nicotine constricts small blood vessels and capillaries, which interferes with the body’s ability to heal bone, increases scar formation, and generally impedes successful bone fusion.
In addition to pre-existing conditions like these, other problems can develop sometimes months or even years after the initial surgery and make revision surgery necessary.
Other common issues and injuries that lead to the need for revision spine surgery include:
- Recurring disc herniation(s)
- Flatback syndrome
- Pseudoarthrosis, or a failure of the spine to fuse properly
- Formation of scar tissue at the surgery site
- Post-surgical infection
- Failure of a spinal implant or hardware during lumbar scoliosis or any scoliosis operation
- Other degenerative changes unrelated to prior surgery (adjacent segment degeneration)
In many cases, these kinds of conditions or complications develop as a result of normal wear and tear on the spine. However, those who work in an occupation that requires manual labor or who have a history of engaging in contact sports or other rough activities may be more likely to need additional surgery.
Is Revision Spine Surgery the only way to treat Failed Back Surgery Syndrome?
In many cases, the physicians at Southwest Scoliosis Institute recommend conservative, non-surgical treatments before suggesting revision surgery. This is because surgery should always be considered as a last resort due to the risks involved.
Conservative treatment includes things like:
- Medications – These may include non-steroidal anti-inflammatories (NSAIDs), nerve pain medications, and if necessary, narcotic pain medications.
- Physical therapy
- Exercise therapy
- Epidural steroid injections (ESIs)
Even though conservative, non-surgical treatment is the preferred starting point. Doctors may recommend immediate revision spine surgery if you are experiencing any of the following conditions:
- Serious nerve-related pain or weakness, shooting pains, and numbness – especially in the legs
- Bowel and bladder dysfunction, which may indicate a rare lower back condition known as cauda equina syndrome
- Spinal instability or pseudoarthrosis
- Broken or displaced spinal instrumentation that could damage nerves or vascular structures
- Spinal infection
Surgical treatments for Failed Back Surgery Syndrome
If your doctor determines that additional surgery is necessary, the goal will be the same as the first – to reduce or eliminate your pain and other symptoms and allow you to return to life as normal.
To do this, revision spine surgeries typically fall into one of two categories: decompression surgery or stabilization surgery. In some cases, decompression and stabilization are performed at the same time.
Common decompression surgeries include:
- Discectomy or microdiscectomy – involves the removal of a herniated or damaged disc that is pressing on the spinal cord or nerves.
- Foraminotomy – the surgeon enlarges the opening(s) between the affected vertebrae through which the nerve roots exit the spine.
- Laminotomy and laminectomy – involve partial or complete (respectively) removal of the lamina, which is the rear portion of the vertebrae.
The goal of any decompression surgery is to relieve pressure on the spinal cord and nerves, but decompression surgery alone may lead to additional problems by causing spinal instability in the tradeoff to create additional space between your vertebrae.
This additional space allows the vertebrae to move more freely than they should, and this can make your spine less stable. If a decompression surgery threatens the stability of your spine, your surgeon will also perform a stabilization procedure during the same surgery.
The primary surgery to stabilize the spine is a spinal fusion, which is designed to limit any abnormal motion or range of motion between vertebrae. This prevents the vertebra from moving too much or moving out of place, which can cause them to put pressure on the spinal cord and nerves.
By fusing together two or more vertebrae, usually with the addition of a bone graft, a spinal fusion procedure allows the vertebrae to grow together, or fuse. Because this takes some time, a spinal fusion is typically held in place with instrumentation (rods and screws) that supports the healing bone and allows your spine to fuse properly.
How do doctors determine if a patient needs revision surgery?
To properly test for and diagnose a patient with FBS, the physicians at Southwest Scoliosis Institute perform a number of diagnostic tests that are critical to discovering exactly what caused the initial surgery or surgeries to fail and determine the best way to fix the issue.
Evaluations and testing always start with a thorough examination, during which the physician will carefully go over your medical history with the patient. Next, they will utilize state-of-the-art imaging EOS technology to get an accurate model of your entire spine.
Diagnostic imaging options may include:
- X-ray imaging to check spine alignment and ensure that any implanted hardware is intact
- Computed tomography (CT) scans to determine if vertebrae have fused properly and check for things like fractures
- Magnetic resonance imaging (MRI) scans to detect nerve compression or herniated discs
- Electromyography (EMG) to study nerve functions
- Bone scans to rule out the possibility of infection
Once these tests have been performed, our team of experts will review the findings to diagnose the problem and make recommendations regarding the best possible course of treatment. The physician will then sit down with the patient to discuss all of the options available, as well as answer any questions they may have.
Revision Spine Surgery recovery
Depending on the exact procedure performed and the reason for revision surgery, recovery times for each patient will vary. However, most surgeries will at least require the patient to stay in the hospital for several days to allow their scoliosis specialist to monitor them and ensure there are no immediate complications.
After the surgery, patients may be fitted with a temporary brace or collar to help keep their spine stable during recovery, and during the first few post-operative weeks, they will be extremely restricted as to what kinds of activities they can perform.
However, as healing progresses, the patient will slowly be able to resume normal activities again. That’s why physical therapy after surgery is so important and should begin as soon as possible to help them regain the necessary strength and mobility.
Depending on the nature of the revision spine surgery performed, recovery times typically vary between six weeks and three months, with a full recovery usually happening by six months.
The exception is that some revision spine surgeries can be performed using minimally invasive techniques, in which the surgery is done by making small incisions and specialized surgical instruments. This method causes less damage to the muscles and connective tissues surrounding the spine and usually involves a much quicker recovery time compared to traditional open surgical methods.
Southwest Scoliosis Institute specializes in treating complex spine conditions and revision surgery
If you think you may need revision spine surgery, it’s critical to consult a physician who is skilled in performing these kinds of complex procedures – especially if it’s the result of an earlier surgery performed by another surgeon.
At Southwest Scoliosis Institute, our board-certified, fellowship-trained orthopedic surgeons have performed more than 5,900 successful spine surgeries, helping more than 30,000 patients.