Every revision spine procedure should be considered complex and potentially hazardous. As such, a second opinion is highly recommended.
Over the past two decades, spine surgeons throughout the United States have leveraged improved surgical technology and potentially more minimally invasive techniques to offer patients relief of their neck, back, and extremity pain through surgical decompression and stabilization techniques directed at the spinal column. As a result of this development of surgical implants, instruments, and techniques, more and more individuals each year have been the recipients of such spinal procedures.
Whether it is the result of a more active older population, a genetic predisposition toward degenerative spinal disorders, or the direct fallout from altered spinal mechanics imposed by current spine surgical techniques, it seems that there has been an increase in the frequency of secondary revision spinal procedures performed.
These revision spine procedures carry with them their own inherent risks. Specifically, any revision procedure must consider that the anatomy within the operative site will be distorted from the prior surgery. Typical anatomical landmarks serving as critical points of reference during the approach may not be present. There may exist extensive scar tissue around the nerve and spinal cord structures. The risk of an incidental spinal fluid leak from inadvertent violation of the outer membrane of the spinal cord is more common. The blood flow to, or vascularity of, the operative site may also be compromised which could increase the risk of non-healing of an extensive, multi-level fusion. Unfortunately, not uncommonly, the mere redo dissection through previously operated upon spinal musculature can result in the development of chronic back pain through additional muscle denervation and scarring. It is clear that any patient considering revision spinal surgery should head into such an endeavor with a clear diagnosis and a very specific and well thought out surgical approach. The patient’s expectations must be adjusted to reflect the magnitude of the surgery offered. Given the multiple considerations that one faces upon being offered a revision spine procedure, obtaining an objective second opinion should be thought of as essential. Every revision spine procedure should be considered complex and potentially hazardous. As such, a second opinion will help to provide and to explain alternatives to the proposed treatment and, of equal importance, to provide the prospective patient with an unbiased assessment of potential short and long term outcome that he/she may expect from the proposed surgical procedure.