Revision Spine Surgery
Revision Spine Surgery
Spinal surgeries are fast becoming one of the most commonly performed surgeries in the world. Increase in the general life expectancy of the population, evolution of newer techniques and more sophisticated implants has made spine surgeries easier and safer to perform. With the increase in spinal surgeries, it is expected that the rate for revision spinal surgery will also increase over time.
There are multiple reasons for revision surgery and diagnoses may overlap. They include recurrence, non-union, implant failure, infection, adjacent segment disease, flat back fusion etc., Careful patient selection and meticulous surgical technique may decrease the need for revision surgery. Even with these precautions, however, the need for revision spinal surgery cannot be avoided in many cases.
Revision surgery can be challenging for the treating surgeon technically, but is also associated with higher procedure related complications and longer hospital stay despite similar baseline comorbidities. When undertaking a revision spinal surgery, certain factors must be considered that are not present during a primary operation. General wound care is imperative because vascular supply may be compromised in revision surgeries. Epidural fibrosis and scarring can make a revision surgery significantly more difficult and can increase the risk of durotomy. Spinal fusion can lead to accelerated degeneration at adjacent levels, whereas extensive laminectomy can result in future instability.
As with any surgical procedure, proper patient selection is imperative in achieving a successful outcome. In addition, the preoperative workup in the potential candidate for revision spinal surgery should include evaluation for scar tissue, instability, and possible new lesions. Myofascial pain should also be considered, and only candidates in whom adequate course of conservative therapy has failed should be considered for revision surgery.
The outcome of revision surgery may be predicted by the patient’s outcome after the primary surgery. In conclusion, good clinical results can be achieved with revision surgeries, but with inferior results compared to primary interventions.
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