What Is Revision Spinal Surgery?
Revision spinal surgery is a procedure that takes place on a patient who has already undergone some form of spine surgery. Typically, by three months following surgery, any lingering pain is resolved. When a patient reports persistent, recurrent, or new chronic pain symptoms, revision spinal surgery is sometimes considered. Revision spine surgery is typically performed on the cervical or lumbar spine areas. In the cervical spine, patients may be suffering from failed cervical disc replacement surgery whereas in the lumbar spine patients may be suffering from a failed fusion or pseudoarthrosis.
Revision spinal surgery may also be related to the re-herniation of a disc, infection, hardware failure, non-surgery-related spine degeneration, instability, adjacent segment degeneration, or pseudarthrosis (failure to achieve solid fusion). Failed spine surgery can occur due to an inaccurate diagnosis that results in the wrong surgical approach and/or inadequate surgical correction. At Princeton Neurological Surgery, Dr. Lipani often corrects patients who’ve suffered failed spine surgery at other institutions. His extensive experience includes correcting failed cervical and lumbar decompression (e.g., discectomy, laminectomy), cervical and lumbar fusion, and failed cervical artificial disc surgery.
What are the symptoms that I may need revision spine surgery?
The symptoms a patient may need revision surgery typically involve pain that wasn’t resolved by the previous surgery or new pain that comes from something like hardware in a fusion procedure breaking or coming loose. These could be symptoms that you could require revision spine surgery:
- New or worsening nerve problems like shooting pain, numbness, or muscle weakness
- Bladder or bowel dysfunction
- Cauda equina syndrome
- Increased spinal instability or pseudoarthrosis
- Spinal instrumentation that has broken or moves out of place
- A spinal infection
Do You Need Repeat Spine Surgery?
In other instances, factors besides pain can necessitate revision spinal surgery. These may include persistent or worsening numbness, tingling, or weakness involving one or more extremities due to improper diagnosis by a previous surgeon. In this case, revision surgery may be warranted because an earlier surgery did not correct the existing problem.
“Dr. Lipani is the finest neurosurgeon! Compassionate, Caring, Down to Earth with his professionalism; he is the best! My son Alan, had an L-4/ L/5 Spine Fusion, 7.5 hour surgery and I can not thank the “Great Doctor”/Surgeon for his dedication, kindness and caring.” – Alan B.
“The Doctor outstanding in every way possible. Explaining every detail and taking his time to do so. Amazing for a surgeon to be so informing of the procedure to me and my wife. After the surgery he came out and explained everything to me. My wife is doing great after the cervical spine fusion, moving her arm in ways she hasn’t in years and getting her feeling back in her fingers” – Anthony R.
“Dr. Lipani and his staff are excellent. Dr. Lipani was very thorough. He explained what needed to be treated and why. He has terrific bedside manners. He answered all my questions patiently. Did not rush me at any time. I recommended him to one of my friends and she was extremely happy with him too.” – Poornima S.
What are the benefits of having revision spine surgery?
When a patient has opted to have spine surgery, they are usually at the end of their proverbial rope. Chronic pain has become debilitating and has begun to impact various aspects of their life. From difficulty sleeping to the inability to walk the dog around the block to barely being able to make it around the grocery store, chronic pain usually caused by a compressed spinal nerve or nerve root can make every day a chore.
So, the patient has chosen to have spine surgery, such as a laminectomy, fusion, or a cervical microdiscectomy, to address the pain. When a procedure fails to put much of a dent in the pain, or when tingling or weakness in the arms or legs remains, there is a good chance your original spine surgery failed.
Revision spine surgery with Dr. Lipani can get things right. Different aspects of the previous procedure could have failed, or the patient could have actually had a re-herniation of a disc or another issue.
Regardless of what’s happened before, revision spine surgery can get things right. Sometimes the previous surgery involved an inaccurate diagnosis. Sometimes the decompression wasn’t fully achieved and the nerve in question is still under some pressure. Dr. Lipani approaches these cases as if this is a first-time surgery, seeking to successfully address the patient’s ongoing pain.
Although it may have taken an additional surgery, patients are usually pleased with their reduction in pain or complete lack of pain after their revision spine surgery. This allows them to get back to all of the things they had been avoiding due to their serious back and leg pain.
Revision Surgery For The Spine
Fusion failure is often a problem that results in a need for revision spinal surgery. Although spinal fusion is performed to successfully treat chronic neck and back pain that results from a number of different causes, sometimes these procedures are unsuccessful. Failed fusions may occur because the patient did not heal properly oftentimes due to chronic illness that results in immune suppression such as diabetes or renal failure. When a patient fails to fuse (e.g., when 2 vertebrae fail to connect to become one bone) the internal hardware may loosen within the bone causing the spinal segment to become unstable. Other complications of spinal fusion include eventual spinal degeneration just above or below where the fusion was performed. A patient may also develop recurrent or worsening spinal stenosis or spinal instability at adjacent levels.
Revision surgical fusion involves implanting a new bone graft to the affected area, as well as an external bone growth stimulator to promote bone formation in some cases. Previous instrumentation placed within the spine may be removed and replaced during this procedure to allow the new bone graft to take and heal properly.
What is recovery like after revision spine surgery?
These procedures will always require a hospital stay of a few days. Recovery varies depending upon the procedure needed to correct the previous surgery. These recoveries for a second surgery aren’t any different or more involved than the original surgery. Obviously, if Dr. Lipani feels a previous surgery performed elsewhere involved an inaccurate diagnosis and subsequently the wrong surgical approach, he will advise a different path. This could change the patient’s recovery due to the changing surgery.
Generally, any recovery from a revision spine procedure will take anywhere from 6 weeks to 3 months for a full recovery.
The Decision To Undergo Repeat Spinal Surgery
The decision to undergo revision spine surgery depends on the diagnosis made after the initial failure. In many cases, the cause of spinal surgery failure is complicated and therefore may only be accurately assessed by spine surgeons with extensive experience treating failed spinal surgery. Revision spine surgery is a much more complicated procedure than initial spine surgery and carries more risks for patients. Despite this, revision spine surgery can restore a patient’s quality of life with an accurate diagnosis and appropriate surgical approach.
What People Say About Us!
Princeton Neurological Surgery is truly unbelievable!! The office staff is tremendous - they are always available and return calls promptly. Cathy the office manager goes out of her way to assist you. Getting an appointment is super easy and you are seen promptly. Dr. Lipani takes his time and listens - never rushed! The office staff will follow up and stay in touch with you even after appointments or procedures. We drive almost an hour from Edison to the office simply because of Dr. Lipani and his team. I recommend Princeton Neurological Surgery to anyone who is starting the process of finding a doctor or someone who is not happy or needs a second opinion.
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What are the risks involved with revision spine surgery?
Because revision surgery often has to address problems, such as failed fusion, from the previous surgery, these revision procedures can be much more complicated than the original procedure. As such they carry a higher level of risk. There is a higher risk of infection following a second surgical procedure. There is a higher risk the tissues will not heal properly.
Still, Dr. Lipani is a board-certified neurological surgeon. Thanks to his training, expertise, and experience — having performed over 4,000 brain and spine surgeries — you can rest assured that he can help you get past your chronic pain with revision spine surgery.
Does insurance cover revision spine surgery?
The question of whether an insurance company will cover revision spine surgery can vary depending on the plan particulars and the insurer. Most of these procedures are deemed to be medically necessary and are covered. But some insurance companies balk at coverage.
At Princeton Neurological Surgery, we work with your insurance company to garner the highest level of coverage possible. Often this involves concrete proof in the form of MRIs and the like that the previous procedure either failed, as in a fusion procedure, or didn’t fully complete the job, such as when a herniated disc wasn’t completely removed from an affected nerve in a discectomy or foraminotomy.
What is the cost of a revision spine surgery?
These costs vary widely depending upon what Dr. Lipani proposes for your revision surgery. Different procedures involve different costs. Once Dr. Lipani meets with you for your consultation and gets a good idea of what is needed for your revision surgery, he can then give you a good estimate of what the surgery will cost.
Is it Possible to Avoid Failed Back Surgery?
Spine surgery can be remarkably effective at reducing or eliminating chronic pain. By far, the primary reason that patients consult with Dr. Lipani for revision spine surgery is that they continue to experience pain after their procedure. Often, the reason for this continued pain is that the initial surgery operated on a structural issue that was not the direct cause of nerve compression.
Some of the reasons for failed back surgery include:
- Failure of spinal structure to properly fuse.
- Recurrent spinal stenosis or disc herniation after decompression surgery.
- Inadequate decompression of the nerve root.
- Scar tissue formation around a nerve root.
- Continued pain originating from a secondary generator.
Spinal surgery is nuanced in nearly every situation. The term "failure" doesn't ascribe blame to the patient or doctor in most cases but is simply a matter of inadequate healing based on numerous physiological factors.
What Can I Do After Revision Spine Surgery to Optimize My Recovery?
Recovery from spinal surgery can look different for every patient. It's important to follow your surgeon's aftercare instructions to heal as best you can, and also to understand that there may be recovery factors that are beyond your control. For example, multiple studies have shown that older patients can take longer to recover from any type of surgical procedure than younger people.
The benefit of recognizing factors that contribute to your surgical recovery is that you can address those that you can control. For example, if you have spinal surgery or revision spine surgery at an older age, you can harness all other factors that can help you recover more optimally. These include resting as your body requires and eating a nutrient-dense diet after your back surgery.
Activity is an integral aspect of recovery from spinal surgery. It may feel like a fine balance at first. You need to walk short distances several times a day as soon as possible after surgery. This is one of the best ways to prevent blood clots in the legs. At the same time, you'll need to avoid movements that can put stress on the spinal segment that's been treated. Your post-operative instructions may advise you to avoid twisting, lifting, or bending. In general, you may need to move slowly and with more caution than usual.
To optimize your surgical recovery from a first or revision spinal procedure, consider the following suggestions:
- Balance your activity levels. At first, you may need to push yourself just a bit to balance the ratio of lying down to moving around. The less you move after having back surgery, the more likely it is that your muscles will weaken and stiffen. The spinal joints rely on regular movement (without stress) to sustain optimal lubrication. Joint mobility can decrease significantly after just a few days of being sedentary.
- Think ahead. Depending on your current condition, previous surgery, and other factors, Dr. Lipani may discuss the benefits of pre-surgical physical therapy. This may be best described as "prehabilitation." Beginning physical therapy before revision spine surgery may help strengthen the muscles around the joint or joints to be addressed, thereby facilitating an optimal outcome and shorter recovery period.
- Commit to post-surgical rehabilitation. Whether or not you participate in physical therapy before your revision spinal procedure, it's important that you commit to full, prompt, and consistent engagement in all post-operative rehabilitation recommendations. This includes physical therapy as well as activity restrictions as needed based on your procedure.