When considering spine surgery, it is critical to do everything you can to fix the problem right the first time around. The chances of success are always higher during the first surgical procedure. Given the large number of factors that can be involved, it is always best to carefully evaluate all of the potential options in order to make the best possible choice about what structure in the spine is actually causing the pain and how to best address it.
Despite the challenges that come with taking care of patients that have suffered failed spinal surgeries, in many ways these are some of the most fulfilling patients we treat. Many patients with a failed surgery have tremendous difficulties and when we can find a treatable cause and fix it, the improvement in their quality of life can be tremendous.
For patients who suffer with Failed Neck & Back Surgery Syndrome , it is very important to try to understand which of the potential causes maybe playing a role. In order to improve the chances of success, understanding and prioritizing each of these factors and trying to optimize as many as possible can be very important. Revision or “redo surgical procedures” are more technically challenging and complex than original surgical procedures but in many cases can still offer a patient a tremendous improvement in their quality of life. That being said, we should always try to look at all the factors and optimize our chances of getting things right the first time!
There are a number of factors that can contribute to a failed back or neck surgery and in order to maximize chances of successful corrective surgery, it is important to understand the reason (or reasons) that the first surgery was not successful. With all types of spine surgery, it is extremely desirable to “get it right the first time” because many corrective or revision surgeries are more delicate than the original surgery. In some cases, a definitive cause cannot be identified and in some cases additional correction may not be an option, but everyone who has had a failed back surgery should consider getting a thorough evaluation to understand the causes and their options for corrective treatment.
Below are some of the most common potential causes of failed neck or back surgery.
Recurrent (repeat) disc herniation
Adjacent level disc breakdown or disc herniation
Proximal junctional kyphosis (PJK)
Fracture at or adjacent to a fusion
Spinal fluid leak
Failed Neck & Back Surgery Syndrome is a broad topic as multiple different scenarios, examples listed above, can warrant a revision surgery. That being said often patients present because they had a previous surgery and never felt fully improved after that procedure. Some patients also will describe pain that worsens after surgery or returns shortly after. These symptoms can include neck, mid or low back pain possibly extending into the arms and/or legs. Patients may also experience numbness and tingling as well.
When patients are seen by our specialists at the Virginia Spine Institute a thorough examination is completed. Not only are patients examined to evaluate their strength, sensation, or any changes in neurologic reflexes but imaging is also obtained and reviewed. Through our physical examination and patient interview we may be suspicious of the underlying cause of pain however it cannot be diagnosed until imaging studies are obtained.
We highly recommend patients that are presenting to discuss previous surgical issues or have a history of previous spinal surgery bring any CT, MRI, or x-ray imaging with them as it will be reviewed. We may need to update these imaging studies if they are outdated or not the particular study which may be needed. Sometimes we may order new studies to evaluate soft tissue structure (MRI), bony anatomy (CT), nerve conduction (EMG or electromyography) or possibly studies to evaluate bone density (DEXA). All of these possible imaging modalities together helps determine the underlying diagnosis.
Treatment for a revision spine surgery is dependent on the underlying condition causing symptoms. Frequently when patients are initially seen we often will revamp non-surgical care first. Sometimes patients may be frustrated with failure of previous non-surgical means and wish to discuss surgical treatment options first. It is our goal as medical providers to treat the patient to improve their pain and educate patients on all of the available treatment options both non-surgical and surgical. Some spinal issues cannot be treated conservatively in which case sometimes we will initially discuss surgical intervention. Common surgical treatment options include revision decompression, laminectomy or microdiscectomy or possibly even a revision fusion surgery. There are several different treatment options depending on the underlying issue.
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“I’m back to living an active lifestyle after spine surgery!”
Reviewed by: Dr. Christopher Good, MD, FACS.