Understanding Revision Spine Surgery: A Patient Education Guide

Spine surgery can significantly improve quality of life for patients with chronic back pain, nerve compression, or spinal instability.  However, not all spine surgeries lead to the desired outcomes.  In some cases, pain may persist, symptoms may worsen, or new issues may arise.  When this happens, revision spine surgery may be necessary to address the problem.  This guide provides a detailed overview of revision spine surgery, including reasons for the procedure, common conditions it addresses, the surgical process, recovery, and potential risks.

At Endoscopic & Minimally Invasive Spine Specialists, we have extensive experience and expertise with revision spine surgery and provide the highest-quality care in surgical and non-surgical spine care. 

This guide will help you understand the condition, the procedure, its benefits, risks, and the recovery process.

What Is Revision Spine Surgery?

Revision spine surgery is a follow-up procedure performed to correct or improve the results of a previous spinal surgery.  While many people may be reluctant to undergo initial operative care for their spinal problems, there is even greater hesitation when people are in a position to consider additional operations, especially if their initial problem was not corrected the first time.  In many, if not most cases, the revision procedure is being offered by a different surgeon than performed the original operation.  The goals of revision surgery can include:

1. Relieving persistent or recurring pain.
2. Addressing complications from the original surgery, such as infection or hardware failure.
3. Correcting spinal alignment or instability.
4. Improving overall function and quality of life.

Revision surgery is often more complex than the initial operation due to scar tissue, altered anatomy, or the need to remove or replace hardware.  It requires careful planning and evaluation by a skilled spine specialist.  In many cases, at Endoscopic and Minimally Invasive Spine Specialists, we attempt to use access corridors that avoid the prior scar tissue. 

Reasons for Revision Spine Surgery

There are several reasons why a patient might need revision spine surgery, including:

1. Failed Back Surgery Syndrome (FBSS):
   • A term used to describe persistent or worsening pain after spine surgery. 
   • Causes may include incomplete nerve decompression, incorrect diagnosis, or new spinal issues developing after the initial procedure.
2. Recurrent Disc Herniation:
   • In some cases, the same disc that was previously operated on can herniate again, causing recurrent or renewed pain and nerve compression.
3. Adjacent Segment Disease (ASD):
   • Degeneration of the spinal segments above and/or below a previous fusion site, leading to pain and instability.
4. Hardware Complications:
   • Problems with surgical implants, such as screws, rods, or plates, which may loosen, break, or cause irritation.
5. Infection:
   • An infection in the surgical site can lead to pain, swelling, and the need for hardware removal or debridement.
6. Spinal Instability:
   • Inadequate stabilization from the initial surgery may result in persistent instability, requiring additional fusion (extension) or correction (revision).
7. Persistent Nerve Compression:
   • If the original surgery did not fully decompress the nerves, symptoms like pain, numbness, or weakness may continue.
8. Incorrect Diagnosis or Treatment:
   • If the initial surgery targeted the wrong spinal level or condition, or the approach was questionable, revision surgery may be necessary to address the true source of the problem.

Common Types of Revision Spine Surgery

The type of revision spine surgery depends on the underlying issue and the prior surgical procedure. Common types include:

1. Revision Decompression Surgery:
   • Removes residual bone, disc material, or scar tissue compressing the nerves.
   • Includes terms such as laminectomy, foraminotomy, and discectomy.
2. Revision Fusion Surgery:
   • Strengthens and stabilizes the spine by fusing additional levels or addressing a non-union or failed fusion (pseudoarthrosis).
   • This often requires a combination of removal or adjustment of prior hardware, as well as removal of additional bone or disc material, and possibly extension to additional or adjacent levels. 
3. Hardware Removal or Replacement:
   • Addresses complications such as broken, misplaced, sunken, protruding, or irritating implants.
4. Correction of Spinal Alignment:
   • Treats deformities such as scoliosis or kyphosis that were inadequately corrected or failed subsequent to the initial surgery.
5. Infection Management:
   • Involves removing infected tissue or hardware and administering antibiotics to clear the infection.

Preparing for Revision Spine Surgery

Comprehensive Evaluation

Before recommending revision surgery, your surgeon will conduct a thorough evaluation, which may include:

1. Detailed Medical History:
   • Discuss your symptoms, previous surgeries, and overall health.
2. Physical Examination:
   • Assess your range of motion, strength, and neurological function.
3. Imaging Studies:
   • X-rays, MRIs, CT scans, or bone scans may be used to identify issues such as hardware failure, instability, or nerve compression.
4. Diagnostic Injections:
   • Injections of local anesthetic or steroids may be used to pinpoint the source of pain.

Pre-Surgical Preparation

Once the decision for revision surgery is made, you will receive specific instructions on how best to prepare:

1. Medications:
   • Review medications with your doctor, especially blood thinners, which may need to be paused.
   • Pain medications may require adjustment before and after your procedure.
   • Anti-inflammatory medications may require cessation following the procedure for a short period of time to improve the rate of fusion.
2. Lifestyle Modifications:
   • Stop smoking all substances, as it can impair healing.  
   • Maintain a healthy diet and exercise routine to improve recovery outcomes.
3. Pre-Surgical Testing:
   • Blood tests, heart evaluations, or other assessments may be required to ensure you are fit for surgery.

The Revision Spine Surgery Procedure

Revision spine surgery is typically more complex than initial surgery and may take longer to perform.  The specifics will depend on the type of revision needed.  Here is an overview of what to expect:

1. Anesthesia:
   • The procedure is performed under general anesthesia.
2. Incision and Access:
   • Your surgeon will carefully navigate through or around scar tissue from the previous surgery to access the spine.
3. Problem Identification:
   • The underlying issue, such as hardware failure or nerve compression, is identified and addressed.
4. Correction and Repair:
   • This may involve removing scar tissue, residual or additional disc material, and additional bone, removing, replacing or repositioning hardware, performing additional fusion, or realigning the spine.
5. Closure:
   • Once the necessary corrections are made, the incision is closed, and dressings are applied.

Recovery and Aftercare

Hospital Stay

• Many patients can undergo this surgery as an outpatient, depending on the complexity of the surgery.
• If you require an inpatient admission, this will be planned in advance.
• Pain management will be provided through medications or other methods.

Activity Restrictions

• Avoid heavy lifting, bending, or twisting for several weeks after surgery.
• Follow your surgeon’s guidelines for gradually resuming activities.

Physical Therapy

• Physical therapy is often recommended to improve strength, mobility, and spinal stability.
• Your therapist will guide you through exercises tailored to your recovery stage.

Follow-Up Appointments

• Regular follow-ups are essential to monitor healing and ensure the success of the revision surgery.

Risks and Complications

As with any surgery, revision spine surgery carries potential risks, including:

1. Infection:
   • A small risk of infection at the surgical site.
2. Bleeding or Nerve Damage:
   • Rare but possible complications during surgery.
3. Cerebrospinal Fluid Leak:
   • Rare but possible due to scar tissue that formed from the original operation and may leak during surgery.
   • In the event this happens, it will be closed primarily and with additional materials.  
   • If this occurs, you will be recommended to remain on general bedrest with bathroom privileges and upright position for eating for the next 3 days.
4. Scar Tissue Formation:
   • Scar tissue may develop again and contribute to pain.
5. Hardware Issues:
   • New hardware may fail or cause discomfort.
6. Persistent Pain:
   • In some cases, pain may not improve or may recur over time.
7. Anesthesia Risks:
   • Potential complications from general anesthesia, especially in patients with pre-existing conditions.

Benefits of Revision Spine Surgery

While revision spine surgery is more complex, it can provide significant benefits when successful:

1. Pain Relief:
   • Reduction or elimination of persistent pain.
2. Improved Function:
   • Enhanced mobility and ability to perform daily activities.
3. Stability and Alignment:
   • Correction of spinal deformities or instability.
4. Quality of Life:
   • Improved overall well-being and ability to participate in work, hobbies, and family life.

Frequently Asked Questions

1. How long does recovery take?
   • Recovery varies but typically ranges from 3-6 months, with full healing taking up to a year.
2. Will the surgery completely eliminate my pain?
   • While many patients experience significant relief, some may have residual pain.
3. Is revision surgery more painful than the first surgery?
   • Pain levels vary, but advancements in pain management aim to minimize discomfort.
   • It is possible that your pain will improve immediately or very shortly following your revision operation.  But there will always be expected post-operative pain.
4. What happens if revision surgery fails?
   • If revision surgery is not successful, further evaluation and alternative treatments may be needed.

Revision spine surgery can be a challenging but necessary step for patients who have not achieved the desired outcomes from their initial procedure. By addressing persistent pain, instability, or other complications, revision surgery can improve quality of life and restore function. If you are considering this procedure, consult with a qualified spine specialist to discuss your options and develop a personalized treatment plan. Understanding the process and preparing adequately can help ensure a smoother recovery and better outcomes.

To learn how you can benefit from revision spine surgery and patient-centered care your spinal problems, call Endoscopic & Minimally Invasive Spine Specialists today, or book an appointment online.