What it is
Revision surgery is an operation on a spine that has already been operated on. People arrive having had one procedure or several, often having been told different things by different surgeons, and usually with the sense that nobody has explained what actually happened.
This is a particular focus of Dr. Long's practice, and the first appointment is usually spent on diagnosis rather than on planning an operation.
Why a previous operation may not have worked
- The original diagnosis was not the source of the pain
- The right problem was treated at the wrong level
- The decompression was adequate but the segment is unstable
- A fusion has not united, or implants have loosened or broken
- The level above or below a fusion has since degenerated
- The decompression was adequate and the nerve has not recovered
- Alignment was not restored, leaving the spine out of balance
These require entirely different responses, which is why the investigation is the substance of the consultation.
How it is assessed
Everything is reviewed from the beginning: previous operative notes, implant records, and all prior imaging rather than only the most recent scan. New imaging usually includes standing full-length films to assess alignment, flexion and extension views for movement, CT to assess whether a fusion has united, and MRI where nerve compression is suspected. Diagnostic injections are often used to confirm a pain source before anything is planned.
Non-surgical treatment
Frequently the right answer. Pain management, targeted injections, structured rehabilitation and treatment of the non-structural contributors to persistent pain. If the investigation does not identify a problem an operation would fix, Dr. Long will say so.
When surgery is considered
Where the assessment identifies a specific structural problem that surgery can correct: ongoing nerve compression, a non-united fusion, instability, hardware failure, or a deformity that has left the spine unbalanced. The clearer the structural target, the better the result — and the absence of one is a reason not to operate rather than a reason to try.