Revision spinal surgery is a procedure that takes place on a patient who has already undergone some form of spine surgery. Typically, by twelve months after a surgery has been completed, any lingering pain is gone. When a patient is still reporting chronic pain beyond this time frame, or when previously resolved pain returns, revision spinal surgery is sometimes considered.
Factors That Can Contribute to the Need
for Revision Spinal Surgery
There can be a number of factors which can cause lingering or recurrent pain to be present in someone who has already undergone spinal surgery. The need for revision spinal surgery may be related to the re-herniation of a disc, development of a post-operative infection, hardware failure, non-surgery related spine degeneration, flat back syndrome, instability, adjacent segment degeneration or pseudarthrosis (failure to achieve solid fusion).
Although more common in the past, currently it is fairly uncommon for failure to achieve a solid fusion to be the problem that results in a need for revision spinal surgery. With modern spinal hardware and all the products available to surgeons to help facilitate the bony fusion, re-operation for failed fusion is now rare, although it certainly can occur. It is more common for re-operation in someone with a prior fusion to be necessary due to progression of adjacent segment disease, wherein the discs adjacent to a previously fused segment have undergone accelerated deterioration due to the increased stresses they are subjected to from the previously fused adjacent level.
Revision surgical fusion involves removing some or all of the previously placed hardware, decompressing any nerves that are impinged, adding additional bone graft to the affected area, and adding additional spinal hardware to stabilize the newly operated segments.
Revision Spinal Surgery Decision
The decision to undergo revision surgery is a complicated one and requires the patient and surgeon to have an in depth discussion about the risks and benefits of such a surgery. Success rates vary depending on the cause that has necessitated the need for another surgery, but rarely are they as successful as a first time surgery. Revision spine surgery is a much more complicated procedure than initial spine surgery and carries more risks for patients, including tissues not healing well, increased risk of injury to a nerve root or leakage of spinal fluid, and a higher risk of infection. Only after an in-depth discussion between the patient and their surgeon where realistic expectations can be set should a decision on whether to proceed with surgery be made.