Spinal surgery is commonly done for the purpose of relieving lumbar pain due to compression and/or fusion. The primary target of decompression surgery is to stop back pain due to nerve root pinching that may be caused by either spinal stenosis or herniated disc. The objective of a lumbar fusion is to stop pain due to spondylolisthesis or any lumbar degenerative disc disease.
By nature, any form of surgery entails some risk, more so complex spinal surgery. Statistics indicate that 95% of surgery are effective, and in some cases up to 40% of patients may experience pain due to nerve damage. A failed back surgery syndrome of FBS generally necessitates revision spine surgery.
What is Revision Spinal Surgery?
Standard recuperating period of spinal surgery is about three months. By this time, any lingering back pain should be gone. When chronic pain is still evident, revision spinal surgery is a consideration. This is an operative procedure done to a patient who has had spine surgery. The goal of a revision spinal surgery is to eliminate or significantly reduce pain for the patient to lead a fairly normal life. This procedure is also done to repair an incorrectly done spine surgery, or to address postsurgical complications. Smokers are also at risk of FBS as studies indicate that smoking definitely impairs quick and successful recovery from spinal surgery. It is a fact that nicotine impairs quick bone healing as the substance restricts small blood vessels that could lead to the formation of scars.
Revision spinal surgery may be prescribed to patients who have developed:
- undue scar tissue around the original surgical site
- infection after surgery
- degeneration of the spine that developed after the original surgery
- instability of the spine
- ineffective fusion of bones
In cases of spinal fusion surgery hardware failure is a possibility. Spinal instability or spinal stenosis may occur above or below the fusion site.
Revision spinal surgery consists of imbedding new bone graft in the affected area, with a bone growth stimulator imbedded too. If any hardware was implanted during the original surgery, this would be replaced by a new one for the quick and proper healing of the bone.
Risks of Revision Spinal Surgery
Diagnostics are necessary to determine if there is a need for a revision spinal surgery. A physician may ask for CT (computed tomography) scans to determine if there are no new fractures or if bones have fused. To see possible herniated discs or nerve compression, MRI (magnetic resonance imaging) scans may be ordered. Procedures such as X-rays, EMG (electromyography) and bone scans may be ordered to determine the alignment of hardware, analyze nerve function, and rule infection respectively.
Opting for revision surgery largely depends on the results of the aforementioned diagnostics. The cause of the surgical failure may not be truly known, but the implied complications call to the procedure to be done at the soonest time possible. Revision surgery is deemed more complicated as it presents higher risks for the patient, as improper healing and risk for higher infection. Patient-doctor consultation is highly advised before coming up with the final decision.
If revision surgery is not an option due to certain conditions, there are other options, albeit temporary, to deal with the symptoms of failed back surgery.
Chronic pain can me managed through a doctor-supervised pain management and rehabilitation. Pain relievers and anti-inflammatory drugs such as acetaminophen, aspirin, naproxen or ibuprofen can be prescribed. Stronger narcotics such as fentanyl, codeine, morphine, oxycodone and hydrocodone are very effective for managing chronic pain, but they are highly addictive. Nerve pain drugs such as pregabalin, gabapentin, duloxetine and amitriptyline prove to be effective in some cases.
Surgical treatment options for pain management may include nerve blocking by injecting steroids to reduce pain and inflammation. Spinal cord stimulation by placing electrodes in the spinal canal may also reduce pain. One of the best methods of pain management is by implanting catheters to deliver the pain medication to the spinal fluid.
As the type of revision spinal surgery varies from one patient to another, the recovery period also varies. As a general rule, hospitalization is required after the surgery. Confinement usually takes several days, with some requiring more days to recuperate as affected by their overall health condition. There are those who require with temporary collars or braces to aid in keeping the spine more stable during the healing period. Weeks of recuperation is needed for the patient to fully recover. As the healing process progresses, the patient will gradually regain his strength and get back to doing to his usual activities before the operation. The normal range for the healing and recovery period is from 6 to 18 weeks.