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Thread: why would you need a Revision surgery?

  1. #1
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    why would you need a Revision surgery?

    I am having my first surgery Marhc 11and am just interetsed in whay some people need to have additional surgeries?

    Thanks

    All this is new to me


    Melissa

  2. #2
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    Hi Melissa, revision surgery can come about for a number of reasons. To help you understand more, maybe read the revision surgery posts.
    Vali
    44 years young! now 45
    Surgery - June 1st, 2009
    Dr David Hall - Adelaide Spine Clinic
    St. Andrews Hospital, Adelaide, South Australia
    Pre-op curve - 58 degree lumbar
    Post -op - 5 degrees
    T11 - S1 Posterior
    L4/5 - L5/S1 Anterior Fusion

  3. #3
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    Most don't need revision

    Most people don't need revision surgery. If anyone knows percentages, it would be interesting to see that information posted here. A larger percentage of people with older procedures including Harrington rods needed revision but I believe even that group did not include most people. When I had my surgery, my doctors in Buffalo were doing one per week, and I have never seen any of those people post here. I check in here because I have some developing neurological symptoms from the pressure at the base of my fusion for all these years, but I am a long way from needing revision. Never, I hope. Those who have further surgery usually do so due to severe pain.
    Last edited by JulieBW; 01-26-2010 at 10:58 AM.
    1966 fusion in Buffalo of 11 thoracic vertebrae, with Harrington rod

  4. #4
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    Thanks both for your answers

    I was just wondering as I am getting ready for my first surgery

    Melissa

  5. #5
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    Alot of people don't need revision surgery. The ones that don't have moved on with life and have no need for a forum as this. People who post here normally are having issues but I'm sure it is not the majority. I have had 3 sets of rods in 10 years. I can't speak for anyone else but my reason was PAIN due to failed fusion, loose intrumentation and severe sagital imbalance. Hope this helps. I agree with the 1st and 2nd post. Read the revision posts but don't scare yourself we are the minority!

  6. #6
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    Now I have some more questions

    First why would a fusion fail?

    Second is the loose instrumentation due to the failed fusion?

    And finally third,severe sagital imbalance; what is this?

    Thanks

    Melissa

  7. #7
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    I believe the rate for revision surgery (based on two articles that Linda posted recently) is between 9% (for a study with a large amount of younger adults) and 25% (for a study with more middle-aged adults). The 25% study included only patients with surgery in the last 5 or so years.

    When we asked my doctor, he said curves like my son's (high thoracic) were unlikely to require revision. His experience is that revisions were mainly for curves in the lumbar region.

  8. #8
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    Sorry, should have said the study covered the 5 years starting in 1999.

    Here's the link and abstract:

    http://www.ncbi.nlm.nih.gov/pubmed/1...ystem2.PEntrez. Pubmed.Pubmed_ResultsPanel.Pubmed_SingleItemSupl.P ubmed_Discovery_RA&linkpos=2&log$=relatedarticles& logdbfrom=pubmed

    Reoperation after primary fusion for adult spinal deformity: rate, reason, and timing.
    Mok JM, Cloyd JM, Bradford DS, Hu SS, Deviren V, Smith JA, Tay B, Berven SH.

    Department of Orthopedic Surgery, University of California, San Francisco, CA 94143-0728, USA.
    STUDY DESIGN: Retrospective cohort study of consecutive patients undergoing primary fusion with segmental fixation for adult spinal deformity. OBEJCTIVE: We sought to determine the survivorship of primary fusion for adult spinal deformity and identify patient-specific predictors of complications requiring reoperation. SUMMARY OF BACKGROUND DATA: Compared with the adolescent population, surgery for adult deformity is often more complex and technically difficult, contributing to a high reported rate of complications that can result in the need for reoperation. Reported complication rates vary widely. METHODS: From 1999-2004 all patients who underwent primary instrumented fusion for nonparalytic adult spinal deformity at a single center were included. Inclusion criteria included minimum age at surgery of 20 years and minimum fusion length of 4 motion segments. Surgical, demographic, and comorbidity data were recorded. Reoperation was defined as any additional surgery involving levels of the spine operated on during the index procedure and/or adjacent levels. Comparisons were performed between patients who required reoperation and those who did not. RESULTS: Eighty-nine patients met inclusion criteria. Endpoint (minimum 2 years follow-up or reoperation) was reached for 91%. Mean follow-up was 3.8 years. Cumulative reoperation rate was 25.8%. Survival was 86.4% at 1 year, 77.2% at 2 years, and 75.2% at 3 years. Reasons for reoperation included infection (n = 8), pseudarthrosis (n = 3), adjacent segment problems (n = 5), implant failure (n = 4), and removal of painful implants (n = 3). Multivariate analysis showed smoking was significantly higher in the reoperation group. CONCLUSION: Using a strict definition of reoperation for a well-defined cohort, in the presence of relevant risk factors, many patients undergoing primary fusion for adult spinal deformity required reoperation. The results indicate that complex medical and surgical factors contribute to the treatment challenges posed by patients with adult spinal deformity. This represents the largest cohort reported to date of patients undergoing primary fusion using third-generation instrumentation techniques.

  9. #9
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    Wow
    Thanks for all the information

    Melissa

  10. #10
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    I had revision surgery because my fusion grew on its own and was pressing into my spinal cord. We think it was due to an accident 16 years ago. They thought at the time that my rod might have moved at the base. But because I didn't have any postop xrays that they could compare it to, they couldn't prove it. Always get a copy of you postop xrays!!!!! We got a copy of my daughter's and they are on a disk.
    T12- L5 fusion 1975 - Rochester, NY
    2002 removal of bottom of rod and extra fusion
    3/1/11 C5-C6 disc replacement
    Daughter - T7 - L3 fusion 2004

  11. #11
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    Thanks for the good advice


    Quote Originally Posted by rainbow2010 View Post
    I had revision surgery because my fusion grew on its own and was pressing into my spinal cord. We think it was due to an accident 16 years ago. They thought at the time that my rod might have moved at the base. But because I didn't have any postop xrays that they could compare it to, they couldn't prove it. Always get a copy of you postop xrays!!!!! We got a copy of my daughter's and they are on a disk.

  12. #12
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    If you google sagittal imbalnce and go to spine universe it explains it really well and even shows pictures. I don't know why some fusions fail. As for loose instrumentation; it can be from a bad fusion but doesn't have to be. There is so much info. on the internet and on this site. Search around and you can learn so much....google your key words or on this site just put the key word in the search box and you will see all posts with that key word.

  13. #13
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    Quote Originally Posted by hdugger View Post
    Sorry, should have said the study covered the 5 years starting in 1999.

    Here's the link and abstract:

    http://www.ncbi.nlm.nih.gov/pubmed/1...ystem2.PEntrez. Pubmed.Pubmed_ResultsPanel.Pubmed_SingleItemSupl.P ubmed_Discovery_RA&linkpos=2&log$=relatedarticles& logdbfrom=pubmed

    Reoperation after primary fusion for adult spinal deformity: rate, reason, and timing.
    Mok JM, Cloyd JM, Bradford DS, Hu SS, Deviren V, Smith JA, Tay B, Berven SH.

    Department of Orthopedic Surgery, University of California, San Francisco, CA 94143-0728, USA.
    STUDY DESIGN: Retrospective cohort study of consecutive patients undergoing primary fusion with segmental fixation for adult spinal deformity. OBEJCTIVE: We sought to determine the survivorship of primary fusion for adult spinal deformity and identify patient-specific predictors of complications requiring reoperation. SUMMARY OF BACKGROUND DATA: Compared with the adolescent population, surgery for adult deformity is often more complex and technically difficult, contributing to a high reported rate of complications that can result in the need for reoperation. Reported complication rates vary widely. METHODS: From 1999-2004 all patients who underwent primary instrumented fusion for nonparalytic adult spinal deformity at a single center were included. Inclusion criteria included minimum age at surgery of 20 years and minimum fusion length of 4 motion segments. Surgical, demographic, and comorbidity data were recorded. Reoperation was defined as any additional surgery involving levels of the spine operated on during the index procedure and/or adjacent levels. Comparisons were performed between patients who required reoperation and those who did not. RESULTS: Eighty-nine patients met inclusion criteria. Endpoint (minimum 2 years follow-up or reoperation) was reached for 91%. Mean follow-up was 3.8 years. Cumulative reoperation rate was 25.8%. Survival was 86.4% at 1 year, 77.2% at 2 years, and 75.2% at 3 years. Reasons for reoperation included infection (n = 8), pseudarthrosis (n = 3), adjacent segment problems (n = 5), implant failure (n = 4), and removal of painful implants (n = 3). Multivariate analysis showed smoking was significantly higher in the reoperation group. CONCLUSION: Using a strict definition of reoperation for a well-defined cohort, in the presence of relevant risk factors, many patients undergoing primary fusion for adult spinal deformity required reoperation. The results indicate that complex medical and surgical factors contribute to the treatment challenges posed by patients with adult spinal deformity. This represents the largest cohort reported to date of patients undergoing primary fusion using third-generation instrumentation techniques.
    I need to find out what the average age was for this study. UCSF is really known for doing surgery on older adults. The majority of deformity cases we see are in adults who are 70+ years old.

    A better paper to use for determining revision rates is this one:

    http://www.ncbi.nlm.nih.gov/pubmed/2...m&ordinalpos=5

    "The most common reasons for revision were pseudarthrosis (24/643 = 3.7%; 24/58 = 41.4%), curve progression (13/643 = 2.0%; 13/58 = 20.7%), infection (9/643 = 1.4%; 9/58 = 15.5%), and painful/prominent implants (4/643 = 0.6%; 4/58 = 6.9%). Uncommon reasons consisted of adjacent segment degeneration (3), implant failure (3), neurologic deficit (1), and coronal imbalance (1)."

  14. #14
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    Aug 2008
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    I am having a revision surgery after my orig surgery was done in 2008. I have a sagittal imbalance. This is important to ask your doctor about I believe as I did not know anything about this before my surgery. It is very important for your surgeon to balance your spine correctly during surgery. My lumbar area is not curved in the way it should be now and so it is impossible for me to stand upright, my hips and knees are contracted now because they are trying to compensate, therefore I am in constant pain, and fatigue. Hard to walk and stand, ugh.
    May 2008 Fusion T4 - S1, Pre-op Curves T45, L70 (age 48). Unsuccessful surgery.

    March 18, 2010 (age 50). Revision with L3 Osteotomy, Replacement of hardware T11 - S1 , addition of bilateral pelvic fixation. Correction of sagittal imbalance and kyphosis.

    January 24, 2012 (age 52) Revision to repair pseudoarthrosis and 2 broken rods at L3/L4.

  15. #15
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    Quote Originally Posted by LindaRacine View Post
    A better paper to use for determining revision rates is this one:

    http://www.ncbi.nlm.nih.gov/pubmed/2...m&ordinalpos=5
    Isn't that the one where they had a large number of patients between 18 and 20? I was recommending the UCSF one because it had more mature patients.

    Do we have the full papers somewhere so that we could look at the age breakdown?

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