What it is
Reconstruction of a spine that has lost its alignment — either from adult deformity, or after previous surgery that has not held. It is the largest undertaking in spine surgery, and the part that determines the result happens before the operation, in the planning.
This is the focus of Dr. Long's fellowship training and the core of his practice.
Who it is for
Adults with progressive deformity, loss of standing balance, nerve compression within a curve, pseudarthrosis after previous fusion, implant failure, flat-back after a fusion in poor alignment, or junctional failure at the end of a prior construct.
How it works
Planning begins with full-length standing radiographs and the measurements taken from them. Surgery may combine releases, osteotomies to correct rigid segments, interbody work from the front or side, and posterior instrumentation to hold the correction. The selection of levels — particularly the top and bottom of the construct — is the decision with the greatest influence on whether the correction lasts. Neuromonitoring is used throughout.
Recovery
Typically three to seven nights in hospital, with therapy beginning the day after surgery. Fatigue for several weeks is normal and expected. Return to desk work commonly at six to twelve weeks. The final result continues to settle over six to twelve months.
Risks and alternatives
These operations carry meaningfully higher risk than single-level surgery and the conversation should reflect that: blood loss requiring transfusion, infection, dural tear, neurological injury, implant failure, pseudarthrosis, junctional failure above or below the construct, and medical complications. The alternatives — continued non-operative care, a smaller decompression aimed only at the leg symptoms, or accepting the deformity — are genuine options and are discussed properly rather than mentioned.