Spinal revision surgery

"Beyond relieving patients' pain, what needs to be studied and treated properly is the origin of the symptoms".

DR. VICTOR RODRIGO PARADELLS
SPECIALIST. NEUROSURGERY DEPARTMENT

Despite the fact that spinal surgeries are showing an increasing degree of satisfaction, there is a group of patients who unfortunately do not report a complete resolution of their ailments or even describe them as getting worse.

While there are some proven causative factors for this treatment failure (psychological, social, etc.), on other occasions it can be attributed to an incorrect selection of patient, surgical technique or material used.

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When is spinal revision surgery indicated?

There are a multitude of scenarios in which a patient may indicate a re-intervention.

Most frequent indications of this treatment:

  • Disease of the level.
  • Pseudoatrosis.
  • Disk relapse.
  • Syndrome of failed back surgery.

Do you have any of these problems?

Spinal revision surgery may be indicated

How is spinal revision surgery performed?

Disk recurrence is a new herniation on the same side and level, after a discectomy for a herniated disk. Usually occurs after months or a few years.

It can occur before or after this period, but the latter is less frequent. Occur about 5% of cases operated.

As in the first diagnosis, the initial treatment is conservative with medication and rehabilitation, but if there is no improvement, a new surgical intervention must be considered.

There is no clear consensus as to whether the second intervention to be carried out is a new discectomy or whether a spinal fixation should be performed, due to the risk of a new recurrence.

In most cases, if the extruded fragment is very clear, we opt for a new simple decompression. If we see signs of instability in the disc plates, we opt for a vertebral fixation, usually by a posterior route.

The disease of the adjacent level or segment is the disorder that occurs in the contiguous levels after a vertebral arthrodesis, although they are not always clinically symptomatic. It is still debated whether the spinal fusion accelerates this disorder or is simply the result of natural degeneration.

The incidence is very difficult to calculate and ranges from 2 to 20% of the arthrodesis performed.

The question is whether this new segment becomes symptomatic. The surgical procedure is the extension of the previous fixation to that level.

Pseudoarthrosis is defined as the absence of evidence of a solid fusion from the year of surgery (some studies speak of more time).

Sometimes there is a rupture of the osteosynthesis used, but a loss of coronal or sagittal balance can also be observed in that segment. They are more frequent in the thoraco-lumbar hinge and in the lumbo-sacral.

The diagnosis of pseudoarthrosis does not always imply a failure of the surgery, since up to 50% of the patients who have been observed with this phenomenon, may be asymptomatic.

The risk factors for this type of complication are: long fixations up to the sacrum, > 55 years, smoking, alcoholism, osteoporosis and vertebral disbalance.

Failed back surgery syndrome is the inability to satisfactorily improve radiculopathy (leg pain) or low back pain after one or several back surgeries.

These patients frequently present very high analgesic requirements and generally cannot return to some of their daily activities or even their own work.

One option for these patients is usually the implantation of a spinal neurostimulator.

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