Page 1 of 4 123 ... LastLast
Results 1 to 15 of 57

Thread: Definition of Revision Surgery

  1. #1
    Join Date
    Sep 2019
    Posts
    132

    Definition of Revision Surgery

    Not quite sure when it's a revision.
    Is it a revision if the surgeon fuses the same vertebrae over again, probably because something went wrong the first time?
    Or is the definition broader? E.g., say you have your lumbar fused, then your thorax starts acting up (adding on, taking on new curvature) and your surgeon fuses that as well. Is that considered a revision?
    Last edited by Tina_R; 01-18-2020 at 07:12 PM.

  2. #2
    Join Date
    Sep 2003
    Location
    Northern California
    Posts
    7,119
    Quote Originally Posted by Tina_R View Post
    Not quite sure when it's a revision.
    Is it a revision if the surgeon fuses the same vertebrae over again, probably because something went wrong the first time?
    Or is the definition broader? E.g., say you have your lumbar fused, then your thorax starts acting up (adding on, taking on new curvature) and your surgeon fuses that as well. Is that considered a revision?
    I don't think there's any formal definition. At UCSF, we defined it as anything that was in or immediately adjacent to a previous fusion. In the big picture, it doesn't really matter, as what it's called doesn't change a single thing about the procedure.
    Never argue with an idiot. They always drag you down to their level, and then they beat you with experience. --Twain
    ---------------------------------------------------------------------------------------------------------------------------------------------------
    Surgery 2/10/93 A/P fusion T4-L3
    Surgery 1/20/11 A/P fusion L2-sacrum w/pelvic fixation

  3. #3
    Join Date
    May 2008
    Location
    reno,nevada
    Posts
    4,104
    To revise means to change something that "already exists". The prefix Re means again.
    https://dictionary.cambridge.org/dictionary/english/re

    If an implant or screw needs to be changed, that would be a revision surgery.

    If a patient has an infection, and they have to go in again on the same areas, that would be a revsion surgery

    If you have an extension to your fusion on new levels, that would not be a revision. Its an extension of an existing fusion in a new area. If I have my neck fused some day, that would not be a revision surgery.

    I would not consider a PJK a revision surgery since the operating area does not exist.

    ================================================== ===========================================
    For Engineering documents, engineers revise existing data. The revision designation of the document has more value than the original document because the change, or changes can be significant.

    Revision checks on documents are extremely serious.

    For example
    Title: Airplane 737 Max "Revision A" (Has software problems) and crashes
    Title: Airplane 737 Max "Revision B" (Has new and improved software) does not crash

    Which revision are we running again? Everyone needs to ask this question.
    ================================================== ===========================================
    If hardware breaks for a particular reason and new hardware is developed, hardware manufacting companies can be forced to purge or destroy exixting hardware. If inspectors or any ISO system or FDA auditers catch any mistakes, (old rev hardware, or even quality system mistakes) a company can be forced to destroy ALL product is has. Each and every item on the shelf destroyed. Including all tooling on said product which is worth substantially more.

    I have seen this happen. I will not reveal which medical company did this. (BTW, This company did not have a hardware problem, they had a quality system problem)

    Which is WORSE because they dont even know or even prove their product is acceptable.

    Its so important to know why and how mistakes happen.......... It makes it so difficult when failure happens and we dont know why.

    Ed
    49 yr old male, now 61, the new 61...
    Pre surgery curves T70,L70
    ALIF/PLIF T2-Pelvis 01/29/08, 01/31/08 7" pelvic anchors BMP
    Dr Brett Menmuir St Marys Hospital Reno,Nevada

    Bending and twisting pics after full fusion
    http://www.scoliosis.org/forum/showt...on.&highlight=

    My x-rays
    http://www.scoliosis.org/forum/attac...2&d=1228779214

    http://www.scoliosis.org/forum/attac...3&d=1228779258

  4. #4
    Join Date
    Sep 2019
    Posts
    132
    Quote Originally Posted by LindaRacine View Post
    I don't think there's any formal definition. At UCSF, we defined it as anything that was in or immediately adjacent to a previous fusion. In the big picture, it doesn't really matter, as what it's called doesn't change a single thing about the procedure.
    It doesn't change the procedure, but it has a huge effect on statistics. There is a thread somewhere here about the rate of revision surgeries. That's why I ask.

  5. #5
    Join Date
    Sep 2003
    Location
    Northern California
    Posts
    7,119
    Quote Originally Posted by titaniumed View Post
    To revise means to change something that "already exists". The prefix Re means again.
    https://dictionary.cambridge.org/dictionary/english/re

    If an implant or screw needs to be changed, that would be a revision surgery.

    If a patient has an infection, and they have to go in again on the same areas, that would be a revsion surgery

    If you have an extension to your fusion on new levels, that would not be a revision. Its an extension of an existing fusion in a new area. If I have my neck fused some day, that would not be a revision surgery.

    I would not consider a PJK a revision surgery since the operating area does not exist.
    Ed...

    I'm fairly certainly that's almost exactly opposite of what most, if not all, of the best surgeons would say. For purposes of multi-center studies, infections are never considered a revision. Extension of fusion (which includes surgery for PJK), is always considered revision. The only questionable procedure is swapping out or removing a screw.

    --Linda
    Never argue with an idiot. They always drag you down to their level, and then they beat you with experience. --Twain
    ---------------------------------------------------------------------------------------------------------------------------------------------------
    Surgery 2/10/93 A/P fusion T4-L3
    Surgery 1/20/11 A/P fusion L2-sacrum w/pelvic fixation

  6. #6
    Join Date
    Sep 2003
    Location
    Northern California
    Posts
    7,119
    Quote Originally Posted by Tina_R View Post
    It doesn't change the procedure, but it has a huge effect on statistics. There is a thread somewhere here about the rate of revision surgeries. That's why I ask.
    Agreed. Studies are great in terms of making a decision about whether or not to do something. But, it's always important to remember that statistics don't really mean anything in terms of what happens to an individual. Even if 99 out of 100 people don't have any complications, the one person who did have a complication is affected.

    Since you're searching the literature, you might find more targeted info by searching something like "spine non-fusion" or "spine pseudarthrosis", or whatever the specific issue is. The term revision is too broad a bucket.

    --Linda
    Never argue with an idiot. They always drag you down to their level, and then they beat you with experience. --Twain
    ---------------------------------------------------------------------------------------------------------------------------------------------------
    Surgery 2/10/93 A/P fusion T4-L3
    Surgery 1/20/11 A/P fusion L2-sacrum w/pelvic fixation

  7. #7
    Join Date
    Sep 2019
    Posts
    132
    Quote Originally Posted by LindaRacine View Post
    Agreed. Studies are great in terms of making a decision about whether or not to do something. But, it's always important to remember that statistics don't really mean anything in terms of what happens to an individual. Even if 99 out of 100 people don't have any complications, the one person who did have a complication is affected.

    Since you're searching the literature, you might find more targeted info by searching something like "spine non-fusion" or "spine pseudarthrosis", or whatever the specific issue is. The term revision is too broad a bucket.

    --Linda
    I'm not looking for any specific issue, Linda. Just wondering what the odds are, for any reason at all, that someone who has had one spinal fusion surgery will need another one sometime in their life. I think the odds are very high, almost certain. And it's no accident. Fusion causes problems in related areas. It's a flawed treatment. So is chemotherapy.

  8. #8
    Join Date
    Jan 2008
    Location
    NC
    Posts
    9,332
    Quote Originally Posted by Tina_R View Post
    I'm not looking for any specific issue, Linda. Just wondering what the odds are, for any reason at all, that someone who has had one spinal fusion surgery will need another one sometime in their life. I think the odds are very high, almost certain. And it's no accident. Fusion causes problems in related areas. It's a flawed treatment. So is chemotherapy.
    It's going to be a function of the prevalence of each type of curve combined with the likelihood of needing an extension or the likelihood of a complication necessitating another surgery.

    As far as I know, the most prevalent AIS curve is a single T curve followed by a double major.

    A single T curve can be a one-and-done surgery if it ends above about L1 and the lumbar is driven straight enough. If not then another surgery to fuse into the lumbar might be needed. Any fusion that goes much into the lumbar is likely to start a countdown to fusion of the lumbar.

    In re double majors, it is my impression that surgeons simply cannot bring themselves to fuse most of a child's spine and so do not fully fuse the lumbar. It seems like many of these cases will require further fusion because it that wasn't the case then no surgeon would ever fuse into the lumbar in a double major curve.

    There is adding on and proximal junctional kyphosis when the wrong levels are chosen for the end the fusion among other reasons. So those are categories of needing revision but I am not sure what the rate is that these occur.

    Lumbar and triple curves are much less frequent as far as I know and I don't know anything about the revision rate of those.

    It is probably better to investigate what exact type you have and search the literature in the out years after surgery.
    Last edited by Pooka1; 01-19-2020 at 07:30 PM.
    Sharon, mother of identical twin girls with scoliosis

    No island of sanity.

    Question: What do you call alternative medicine that works?
    Answer: Medicine


    "We are all African."

  9. #9
    Join Date
    Jan 2008
    Location
    NC
    Posts
    9,332
    I went back and saw you mention you are fused T9-L5.

    The potential revisions with this include needing to go to S1 and PJK above T9. As I understand it, the former would not surprise anyone but the latter is not a given. I don't think it is known how to predict PJK but they do know a few things.

    Maybe Linda can comment.
    Sharon, mother of identical twin girls with scoliosis

    No island of sanity.

    Question: What do you call alternative medicine that works?
    Answer: Medicine


    "We are all African."

  10. #10
    Join Date
    Sep 2003
    Location
    Northern California
    Posts
    7,119
    Quote Originally Posted by Tina_R View Post
    I'm not looking for any specific issue, Linda. Just wondering what the odds are, for any reason at all, that someone who has had one spinal fusion surgery will need another one sometime in their life. I think the odds are very high, almost certain. And it's no accident. Fusion causes problems in related areas. It's a flawed treatment. So is chemotherapy.
    Totally agree that it's a flawed treatment. I think we'll eventually find that most kids who have spinal fusion surgery, do not require revision surgery. This is something that's been hard to track, because most of these kids are treated by surgeons who specialize in pediatric orthopaedics. They see their patients for a few years and then do no follow-up.

    https://www.ncbi.nlm.nih.gov/pubmed/31925756

    Unfortunately, adults, especially "older" adults, don't fare as well. I've heard numbers as high as 70%. If you've been looking at abstracts, I'm sure you've seen that the numbers are all over the place. Like kids, it's difficult to perform survivorship analysis, as a large percentage of patients don't return to their original surgeon for revision.

    --Linda
    Never argue with an idiot. They always drag you down to their level, and then they beat you with experience. --Twain
    ---------------------------------------------------------------------------------------------------------------------------------------------------
    Surgery 2/10/93 A/P fusion T4-L3
    Surgery 1/20/11 A/P fusion L2-sacrum w/pelvic fixation

  11. #11
    Join Date
    Jan 2008
    Location
    NC
    Posts
    9,332
    Quote Originally Posted by LindaRacine View Post
    Totally agree that it's a flawed treatment. I think we'll eventually find that most kids who have spinal fusion surgery, do not require revision surgery. This is something that's been hard to track, because most of these kids are treated by surgeons who specialize in pediatric orthopaedics. They see their patients for a few years and then do no follow-up.

    https://www.ncbi.nlm.nih.gov/pubmed/31925756

    --Linda
    From that paper...

    CONCLUSIONS:
    Spinal fusion patients report SRS-22 quality of life 10 years after scoliosis surgery that is minimally reduced compared to healthy peers and substantially better than an un-operated cohort of comparably aged scoliosis patients. Adolescents with thoracic idiopathic scoliosis should expect little if any change in their health-related quality of life compared to before surgery, high satisfaction, and a 7.5% chance of revision surgery 10 years after their index spinal fusion.
    This is completely in keeping with my twin daughters, one fused in 2008 and the other in 2009. One was unaware she had a reduced ROM, they both can do ANYTHING, and they feel completely normal. Contrast that with one likely being dead and the other likely severely disabled absent surgery. The surgeon saved their lives.

    It is a small mercy that T curves are the most prevalent in AIS because those seem to have the best chance of never needing more surgery. It is my understanding that even the older techniques such as Harrington rods do not produce as many problems when in the thorax compared to other locations. There is something about T curves that makes them likely to be one and done as opposed to other types of curves. That something is staying out of the lumbar... it seems that most fusions into the lumbar eventually require fusing all the lumbar. So unless the lumbar is completely fused, another operation may be likely to do so. Also PJK is a potential issue in L fusions.
    Sharon, mother of identical twin girls with scoliosis

    No island of sanity.

    Question: What do you call alternative medicine that works?
    Answer: Medicine


    "We are all African."

  12. #12
    Join Date
    May 2008
    Location
    reno,nevada
    Posts
    4,104
    Quote Originally Posted by LindaRacine View Post
    I'm fairly certainly that's almost exactly opposite of what most, if not all, of the best surgeons would say. For purposes of multi-center studies, infections are never considered a revision. Extension of fusion (which includes surgery for PJK), is always considered revision. The only questionable procedure is swapping out or removing a screw.
    How interesting....

    Well, if I have an inection and have my rods removed, I know its not a first time surgery. (smiley face)

    Wonder if Insurance codes have anything to do with this?

    Was scheduled on a 737 Max 8 out of Colombia, (Thats why I mentioned it) and just re-scheduled on a 737-800 which is a different airplane. New Boeing updates 2 days ago with software glitches.
    https://edition.cnn.com/2020/01/17/b...tch/index.html

    Jackie, Good luck tomorrow.

    Ed
    49 yr old male, now 61, the new 61...
    Pre surgery curves T70,L70
    ALIF/PLIF T2-Pelvis 01/29/08, 01/31/08 7" pelvic anchors BMP
    Dr Brett Menmuir St Marys Hospital Reno,Nevada

    Bending and twisting pics after full fusion
    http://www.scoliosis.org/forum/showt...on.&highlight=

    My x-rays
    http://www.scoliosis.org/forum/attac...2&d=1228779214

    http://www.scoliosis.org/forum/attac...3&d=1228779258

  13. #13
    Join Date
    Dec 2008
    Location
    illinois
    Posts
    854
    Thanks Ed. I just checked my chart information to see if there was a time yet. It says removal of lumbar instrumentation. It is thoracic . I guess I better be careful what I sign???
    T10-pelvis fusion 12/08
    Fractured t-9 six days out of surgery
    C5,6,7 fusion 9/10
    PJK at t-9
    T2--T10 fusion 2/11
    Removal of left side t6-t10. 8/14
    C 4-5 fusion 11/14
    Right scapulectomy 6/15
    Right pectoralis major muscle transfer to scapula
    To replace the action of Serratus Anterior muscle 3/16

  14. #14
    Join Date
    Sep 2019
    Posts
    132
    Quote Originally Posted by titaniumed View Post
    How interesting....

    Well, if I have an inection and have my rods removed, I know its not a first time surgery. (smiley face)

    Wonder if Insurance codes have anything to do with this?

    Was scheduled on a 737 Max 8 out of Colombia, (Thats why I mentioned it) and just re-scheduled on a 737-800 which is a different airplane. New Boeing updates 2 days ago with software glitches.
    https://edition.cnn.com/2020/01/17/b...tch/index.html

    Jackie, Good luck tomorrow.

    Ed
    Doesn't it depend on the nature of the infection and what is done to treat it?
    Infection from the operating room can plague any kind of surgery.
    But if rods from fusion show infection years later this seems like something peculiar to putting titanium in people. I don't think infections from other surgeries show such a delay in manifesting themselves. This sounds like a hazard of fusion surgery and I would call removing the rods for this purpose a revision.

  15. #15
    Join Date
    Sep 2019
    Posts
    132
    Quote Originally Posted by LindaRacine View Post
    Agreed. Studies are great in terms of making a decision about whether or not to do something. But, it's always important to remember that statistics don't really mean anything in terms of what happens to an individual. Even if 99 out of 100 people don't have any complications, the one person who did have a complication is affected.

    Since you're searching the literature, you might find more targeted info by searching something like "spine non-fusion" or "spine pseudarthrosis", or whatever the specific issue is. The term revision is too broad a bucket.

    --Linda
    "Even if 99 out of 100 people don't have any complications, the one person who did have a complication is affected."

    Then you'd never have any surgery because there is a small rate of death from almost anything.

    But what if the statistic is that 70% of people who have fusion need revision (which I heard on this forum)? That's certainly sobering and a good reason to think twice about having the surgery. Wouldn't you listen to the statistic in this case? Wouldn't you want to know about this?

    Not only is there that statistic, but it's becoming obvious to me that the surgery brings on the need for more surgeries. There is causation.
    Revisions are needed because the surgery itself inflicts harm, although the manifestation may be delayed by years. Or it may not, it may show up in a few months, like with me.

    I know, the disease is terrible, too. But I think patients have the right to know about the inherent problems of the surgery, and they don't get that information. I received scant information from my surgeon, his renowned hospital, my local "spine center", and my GP.

Posting Permissions

  • You may not post new threads
  • You may not post replies
  • You may not post attachments
  • You may not edit your posts
  •