Revision Spinal Surgery

• Patients with persistent or recurrent symptoms of pain, weakness or other neurological symptoms after a previous back surgery. This could be due to incomplete decompression of nerves, inadequate fusion, recurrent disc herniation, or other causes.
• A failed fusion, where the patient whose spinal fusion surgery did not result in the intended solid bone fusion, leading to instability or persistent pain.
• Patients who develop degenerative changes or symptoms in the spinal segments adjacent to the site of the initial surgery, often due to the increased mechanical stress on those segments due to fusion.
• Patients experiencing issues related to the surgical implants (e.g., screws, rods, cages) used in the first surgery, such as hardware loosening, breakage, or malposition.
• Patients who develop an infection after the initial surgery that may require further intervention, such as the removal of infected hardware or debridement of the infected area.
• Individuals who develop excessive scar tissue around nerve roots, leading to ongoing or new nerve compression and associated symptoms.

The evaluation process for determining whether a patient is a candidate for revision spinal surgery is comprehensive and typically includes:

1. A thorough review of the patient’s medical history, including the details of the initial spinal surgery, the symptoms that led to that surgery, and the course of symptoms since the operation.
2. A detailed physical and neurological examination to assess muscle strength, reflexes, sensation, and overall spinal function. This helps to localize the source of symptoms and determine their severity.
3. Imaging Studies including X-rays CT scans, MRI and sometimes a bone scan.
4. Tests such as electromyography (EMG) and nerve conduction studies (NCS) may be used to evaluate the function of the nerves and muscles
5. A careful review of the operative report and any notes from the surgeon who performed the initial surgery to understand what was done, what complications may have occurred, and why the initial surgery may not have been successful.
6. In complex cases, a multidisciplinary team including spine surgeons, neurologists, pain specialists, and rehabilitation experts may be involved in the evaluation and decision-making process.
7. The patient’s general health, including factors like age, comorbid conditions (e.g., diabetes, osteoporosis), and smoking status, are considered as these can impact the success of revision surgery and recovery.

The type of revision surgery performed depends on the underlying issue:

• Decompression surgery involves removing bone spurs, disc fragments, or scar tissue that are compressing nerves. It may be necessary if the initial decompression was inadequate or if new compression has developed.
• If the original fusion did not heal properly, revision fusion surgery might include additional bone grafting, or the use of different hardware to achieve a stable fusion.
• If there are issues with the implants used in the initial surgery, hardware may need to be removed, replaced, or adjusted.
• In some cases, the surgeon may extend a prior fusion to adjacent levels

Revision spinal surgery carries higher risks compared to the initial surgery due to factors such as scar tissue, altered anatomy, and potential instability. Common risks include infection, bleeding, nerve damage, and a longer recovery time. The surgery may also be more technically challenging, requiring advanced surgical skills and possibly longer operating times.

Patients should be evaluated by a very experienced surgeon like Dr. Matthew Colman who is experienced in revision spine surgery. After the evaluation, he will discuss the findings with the patient, explaining the potential risks and benefits of revision surgery. They will also consider non-surgical options, such as physical therapy, pain management, and lifestyle modifications before recommending revision surgery.

The decision to proceed with revision spinal surgery is made collaboratively, considering the severity of the patient’s symptoms, the likelihood of improvement with surgery, the potential risks, and the patient’s goals and expectations.