Revision spine surgery: Taming the beast!

Some spine surgeons may find revision spine surgeries exciting, while others may find them gloomy and anxiety-inducing (It’s probably a matter of who did the index surgery, you or you are contemporary). However, it is undoubted that revision spine surgery is nightmarish for the patient.

The need for revising a previously operated spine can be of two types: first, a new pathology at a new region has surfaced up, this is medically called as adjacent segment disease when it occurs in the vicinity of previously operated spine; second and more dreadful is when the primary surgery has to be redone as it failed to give the desired outcomes, this is medically called as failed back syndrome.

It takes a giant leap of faith on the patient’s part to forget what happened and get himself ready for another shot. The picture becomes murkier when one looks at the literature putting odds of success and complications against the expectations. This is mostly attributed to two facts:

One is difficulty in pinpointing the root cause of the patient’s problem and the second is scar tissue from previous surgery.

The first challenge of Meticulously targeting the root cause has been accomplished by the combination of increasing clinical experience of treating spine surgeons combined with the availability of cutting edge imaging like 3T MRI, nerve diagnostics like NCS/EMG and imaging-guided nerve/disc blocks. This has helped in tackling the menace of misdiagnosis in Spine and has significantly brought down the number of failed back surgeries.

The next challenge is operating through scar tissue. Surgeries are based upon anatomical reproducibility. Any surgery through any part of the body results in the replacement of normal structures with scar and scars don’t have any anatomy. They are irregular, inconsistent and unreliable. Scar tissue makes it almost impossible to differentiate between different tissues like ligament, muscle, dura, and nerves. The already complex anatomy of the spine region is further complicated by the appearance of scar which diminishes anatomical reliability and thus shoots up complication rates.

The spine team of Narayana Superspeciality Hospital, Gurugram has developed a three-pronged approach to deal with this monster. First, we bring down the tendency of scar formation by using minimally invasive techniques of spine surgery causing minimal tissue damage. Secondly, we use anti-adhesive agents during surgery to bring down the rate of scarring near critical structures like nerve and dura. And finally, we have started using 3D navigation technology to navigate through the scar tissue. We use the tracking probe to orient ourselves in 3D anatomy. This keeps ups oriented about the location of critical structures like nerves and dura and thus helps us to dissect through scar tissue.

The spine team at Narayana Hospital, Gurugram, being a tertiary center, performs a lot of revision spine surgeries (referred to us from smaller centers). With the help of the above-mentioned strategy, We have been able to bring success and complication rates in revision spine surgeries at par with primary surgery. If you or your loved one has been contemplating a revision spine surgery, we suggest you consult us for a thorough spine consult and expert treatment plan.

The writer, Dr. Rajesh K Verma, is Director Orthopaedics, Joint Replacement & Spine Surgery at Narayana Superspeciality Hospital in Gurugram

Narayana Health

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