Rationale of Revision Lumbar Spine Surgery

Revision lumbar spine surgeries are technically challenging with inconstant outcome results. This article discusses the preoperative, intraoperative, as well as postoperative management in these difficult patients. Successful intervention requires a detailed history and physical examination and carefully chosen diagnostic tests. Preoperative planning is paramount in these cases. The decision-making process should address the timing of the surgery, surgical approach, level of interbody fusion required, correction of sagittal imbalance, type of osteotomy, location of the osteotomy, and the end of the construct. Surgeons should be prepared to manage associated complications such as dural tear and massive blood loss. The use of autograft and/or biologic graft is necessary to help in achieving a successful fusion. Postoperative management includes prophylactic antibiotic, anticoagulation, nutritional support, and brace.

[1]  L. Prokuski.  Prophylactic Antibiotics in Orthopaedic Surgery , 2008, Instructional course lectures.

[2]  Warren D. Yu,et al.  Pseudarthrosis of the Spine , 2009, The Journal of the American Academy of Orthopaedic Surgeons.

[3]  M. Neuwirth,et al.  Sagittal Plane Deformity in the Adult Patient , 2009, The Journal of the American Academy of Orthopaedic Surgeons.

[4]  D. Armstrong,et al.  The Role of Amicar in Same-Day Anterior and Posterior Spinal Fusion for Idiopathic Scoliosis , 2008, Spine.

[5]  N. A. Tayyab,et al.  Efficacy of Aprotinin as a Blood Conservation Technique for Adult Deformity Spinal Surgery: A Retrospective Study , 2008, Spine.

[6]  Frank A. Buttacavoli,et al.  Allogeneic Transfusion after Predonation of Blood for Elective Spine Surgery , 2008, Clinical orthopaedics and related research.

[7]  James D. Kang,et al.  Efficacy of Intraoperative Cell Saver in Decreasing Postoperative Blood Transfusions in Instrumented Posterior Lumbar Fusion Patients , 2008, Spine.

[8]  Peter Kruse,et al.  Recombinant Activated Factor VII in Spinal Surgery: A Multicenter, Randomized, Double-Blind, Placebo-Controlled, Dose-Escalation Trial , 2007, Spine.

[9]  Yang-Jin Im,et al.  Spinal Pseudarthrosis in Advanced Ankylosing Spondylitis With Sagittal Plane Deformity: Clinical Characteristics and Outcome Analysis , 2007, Spine.

[10]  L. Lenke,et al.  Comparison of Thoracic Pedicle Screw to Hook Instrumentation for the Treatment of Adult Spinal Deformity , 2007, Spine.

[11]  L. Lenke,et al.  Pseudarthrosis in Long Adult Spinal Deformity Instrumentation and Fusion to the Sacrum: Prevalence and Risk Factor Analysis of 144 Cases , 2006, Spine.

[12]  D. Ohnmeiss,et al.  Failed Back Surgery Syndrome: Diagnostic Evaluation , 2006, The Journal of the American Academy of Orthopaedic Surgeons.

[13]  K. Bridwell.  Decision Making Regarding Smith-Petersen vs. Pedicle Subtraction Osteotomy vs. Vertebral Column Resection for Spinal Deformity , 2006, Spine.

[14]  L. Lenke,et al.  Minimum 5-Year Analysis of L5–S1 Fusion Using Sacropelvic Fixation (Bilateral S1 and Iliac Screws) for Spinal Deformity , 2006, Spine.

[15]  I. C. Tudor,et al.  The risk associated with aprotinin in cardiac surgery. , 2006, The New England journal of medicine.

[16]  L. Lenke,et al.  Comparison of Smith-Petersen Versus Pedicle Subtraction Osteotomy for the Correction of Fixed Sagittal Imbalance , 2005, Spine.

[17]  M. Neuwirth,et al.  Evidence-based review of the role of aprotinin in blood conservation during orthopaedic surgery. , 2005, The Journal of bone and joint surgery. American volume.

[18]  D. Bratzler,et al.  Antimicrobial prophylaxis for surgery: an advisory statement from the National Surgical Infection Prevention Project. , 2004, Clinical infectious diseases : an official publication of the Infectious Diseases Society of America.

[19]  L. Lenke,et al.  Pseudarthrosis in Primary Fusions for Adult Idiopathic Scoliosis: Incidence, Risk Factors, and Outcome Analysis , 2005, Spine.

[20]  P. Gerszten,et al.  Re: Reitman CA, Watters WC, Sassard WR. The Cell Saver in adult lumbar fusion surgery: a cost-benefit outcomes study. Spine 2004;29:1580-1583; discussion 1584. , 2005, Spine.

[21]  C. Reitman,et al.  The Cell Saver in Adult Lumbar Fusion Surgery: A Cost-Benefit Outcomes Study , 2004, Spine.

[22]  D. Bratzler,et al.  Antimicrobial Prophylaxis for Surgery: An Advisory Statement from the National Surgical Infection Prevention Project , 2004 .

[23]  L. Lenke,et al.  Pedicle subtraction osteotomy for the treatment of fixed sagittal imbalance. Surgical technique. , 2004, The Journal of bone and joint surgery. American volume.

[24]  D. Bratzler,et al.  Antimicrobial prophylaxis for surgery: an advisory statement from the National Surgical Infection Prevention Project. , 2004, Clinical infectious diseases : an official publication of the Infectious Diseases Society of America.

[25]  L. Lenke,et al.  Complications and Outcomes of Pedicle Subtraction Osteotomies for Fixed Sagittal Imbalance , 2003, Spine.

[26]  V. Deviren,et al.  Management of Fixed Sagittal Plane Deformity: Outcome of Combined Anterior and Posterior Surgery , 2003, Spine.

[27]  S. Savitz,et al.  Efficacy of prophylactic antibiotic therapy in spinal surgery: a meta-analysis. , 2003, Neurosurgery.

[28]  L. Lenke,et al.  Pedicle Subtraction Osteotomy for the Treatment of Fixed Sagittal Imbalance , 2003, The Journal of bone and joint surgery. American volume.

[29]  F. Barker.  Efficacy of Prophylactic Antibiotic Therapy in Spinal Surgery: A Meta-analysis , 2002, Neurosurgery.

[30]  M. Gardner,et al.  Evaluation and treatment of dural tears in lumbar spine surgery: a review. , 2001, Clinical orthopaedics and related research.

[31]  M. McKeehen,et al.  Anterior lumbar fusion improves discogenic pain at levels of prior posterolateral fusion. , 2000, Spine.

[32]  L. Lenke,et al.  Complications and predictive factors for the successful treatment of flatback deformity (fixed sagittal imbalance). , 1999, Spine.

[33]  Jeffrey C. Wang,et al.  Dural Tears Secondary to Operations on the Lumbar Spine. Management and Results After a Two-Year-Minimum Follow-up of Eighty-eight Patients* , 1998, The Journal of bone and joint surgery. American volume.

[34]  P. Lipsett,et al.  Does intraoperative blood loss affect antibiotic serum and tissue concentrations? , 1996, Archives of surgery.

[35]  Simpson Da,et al.  Usefulness of β2-transferrin assay in the detection of cerebrospinal fluid leaks following head injury , 1992 .

[36]  S. Shapiro,et al.  Closed continuous drainage of cerebrospinal fluid via a lumbar subarachnoid catheter for treatment or prevention of cranial/spinal cerebrospinal fluid fistula. , 1992, Neurosurgery.

[37]  D. Simpson,et al.  Usefulness of beta 2-transferrin assay in the detection of cerebrospinal fluid leaks following head injury. , 1992, Journal of neurosurgery.

[38]  N. Aoki.  Closed continuous drainage of cerebrospinal fluid via lumbar subarachnoid catheter for treatment or prevention of cranial/spinal cerebrospinal fluid fistula. , 1992, Neurosurgery.

[39]  M. Modic,et al.  MR imaging of the postoperative lumbar spine: assessment with gadopentetate dimeglumine. , 1990, AJNR. American journal of neuroradiology.

[40]  B. A. Green,et al.  Closed subarachnoid drainage for management of cerebrospinal fluid leakage after an operation on the spine. , 1989, The Journal of bone and joint surgery. American volume.

[41]  J A McCulloch,et al.  Nonorganic Physical Signs in Low-Back Pain , 1980, Spine.

[42]  American association of critical-care nurses. , 1975, Heart & lung : the journal of critical care.

[43]  C. Larson,et al.  Osteotomy of the spine for correction of flexion deformity in rheumatoid arthritis. , 1969, Clinical orthopaedics and related research.

[44]  J. Enders,et al.  Infectious Diseases Society of America. , 1969, Antimicrobial agents and chemotherapy.