In most cases Revision Surgery is not due to an error or mistake of a previous operation. Spinal surgery is a complex field and even the very best and most experienced surgeons do not always get excellent results. Common reasons for revision surgery include such problems as pseudarthrosis (failure to achieve solid fusion) which may be due to poor tissue healing and patient related factors. Another element to consider is that the spine is a living and dynamic structure. Even after apparent successful surgery the function and shape of the spine can deteriorate requiring further surgery to remedy a problem. Revision surgery is a complex field and each patient must be evaluated and treated in a very individual manner to understand what is causing the problem and how best to address it.The goal of spine surgery is to relieve the patient of pain so that he may resume a normal life. Overall, in the right hands, spine surgery is highly successful and excellent outcomes are achieved. Occasionally a patient will require additional surgery. The reasons for revision surgery may include: re-herniation of a disc, infection, pseudoarthorsis, hardware failure, non-surgery related spine degeneration, Flatback Syndrome, instability, or adjacent segment degeneration. Revision surgery is more complex and should be performed by a spine surgeon experienced in handling scar tissue, performing osteotomies to “loosen” the spine and inducing sagittal and coronal balance. The risks of revision surgery are higher than the patient’s first surgery. There is the chance of residual pain and it is more difficult to restore nerve function. Surgical Treatments : Revision surgery for spinal deformity may involve one or more procedures to address the individual patient’s symptoms and/or progression. The patient’s overall health also guides the orthopedic surgeon’s treatment recommendations. The following are just a few of the scenarios that may be considered: Extension of a previous fusion proximally or distally to address degenerative changes above or below the original fusion. Placement of additional instrumentation; for example, as in patients with pseudarthrosis in whom the initial correction and fusion was performed using only a posterior approach (from the back). In revision surgery, an anterior approach (from the front), and placement of additional instrumentation to create a fusion on the other side of the spine can result in a successful fusion and elimination of instability in the spine. Osteotomies, procedures in which intentional fractures are made in the affected bone or bones to arrest progressive deformity and restore proper alignment. Removal (and possibly replacement) of instrumentation in patients with pain and/or infection associated with these implants. Irrigation and debridement – removal of infected tissue – and antibiotic therapy in the presence of infection. Decompression – a surgery to relieve stenosis, or “pinching” of nerves, by removing the tissue that is pressing on a nerve or nerves. Treatment Outcomes : While excellent results can be achieved with revision surgery, especially when patients receive care from a highly experienced multidisciplinary team, the likelihood of effective symptom control does diminish with each successive revision surgery. Moreover, revision surgeries are associated with a higher risk of complications. Patients who undergo revision surgery primarily to address deformity, and/or to correct spinal coronal/sagittal balance, will most likely see some improvement.

Microscopic discectomy is the most common surgical treatment for ruptured or herniated discs of the lumbar spine. When the outer wall of a disc, the annulus fibrosus, becomes weakened, it may tear allowing the soft inner part of the disc, the nucleus pulposus, to push its way out. This is called disc herniation, disc proplapse or a slipped or bulging disc. (See discussion of herniated disc for more information.) Once the inner disc material extends out past the regular margin of the outer disc wall, it can press against very sensitive nerve tissue in the spine. The disc material can compress or even damage the nerve tissue, and this can cause weakness, tingling or pain in the back area and into one or both legs. Open discectomy uses surgery to remove part of the damaged disc and thus to relieve the pressure on the nerve tissue and alleviate the pain. The surgery involves a small incision in the skin over the spine, removal of some ligament and bone material to access the disc and the removal of some of the disc material.Open discectomy has been performed and improved over the course of the past 60 years. Over time, the procedure has been refined, and improved diagnostic tools—such as magnetic resonance imaging (MRI) and computerized tomography (CT) scans—have allowed physicians to gain a better understand of which patients will have the best results from the surgery. Who is a Candidate for Open Discectomy? Not all patients with herniated discs are candidates for the open discectomy procedure. Most people find pain relief with nonsurgical treatments such as rest, physical therapy, anti-inflammatory medications and epidural injections. However, sometimes the pain does not respond to these therapies and may require a more aggressive intervention. If back and leg pain does not respond to nonsurgical treatment and continues for four to six weeks or longer, the physician may prescribe diagnostic tests, such as X-ray imaging, MRI or a CT scan, to verify the source of the pain. If a diagnosis of herniated disc is confirmed, open discectomy may be recommended. The Procedure : Microscopic (Open) discectomy is usually performed under general anesthesia (the patient is unconscious) and typically requires a one-day hospital stay. It is performed while the patient is lying face down or in a kneeling position. During the procedure, the surgeon will make an approximately one-inch incision in the skin over the affected area of the spine. Muscle tissue is removed from the bone (lamina) above and below the affected disc and retractors hold the muscle and skin away from the surgical site so the surgeon has a clear view of the vertebrae and disc. In some cases bone and ligaments may have to be removed for the surgeon to be able to visualize and then gain access to the disc without damaging the nerve tissue. This is called a laminectomy or laminotomy depending on how much bone is removed. After the Procedure : After surgery, you may feel pain at the site of the incision, and the original pain may not be completely relieved immediately after surgery. Your doctor may prescribe pain medication to ease you through the immediate postoperative period. You will be instructed on deep breathing techniques and encouraged to cough in order to free your lungs of any fluid buildup that may occur due to the general anesthesia. It is recommended that, with supervision, you begin walking as soon as you are fully recovered from the anesthesia. This will aid in your recovery. Before you are discharged from the hospital, a physical therapist may visit with you to help you feel comfortable performing activities such as climbing stairs, sitting and getting out of a car or bed. Once you are discharged from the hospital, your physician may prescribe a physical therapy regimen suited to your condition. At home, you may have some minor restrictions such as not sitting for long periods of time, lifting objects more than five pounds, or excessive bending or stretching for the first four weeks after surgery. Also, you should not attempt to drive an automobile until you have been instructed to do so by your physician.

Dr Shailesh Hadgoankar and his support team are well qualified to offer surgical treatment for the whole spine extending from the neck to the lower lumbar spine which includes the management of degenerative disorders in the cervical, thoracic and lumbar spine (disc herniation, spinal stenosis, myelopathy, spondylolisthesis), fractures and dislocations at all levels of the spine, Spinal deformity (scoliosis and kyphosis) and infections in the spine.