Revision Spine Surgery
When Pain Persists After Spine Surgery
Revision spine surgery addresses symptoms that continue or return after a prior spinal operation. These are among the most complex cases in spine surgery. They require a detailed understanding of what was done before, what the imaging shows now, and what is producing the current symptoms.
Patients arriving for a revision evaluation have often been told that nothing more can be done. An evaluation begins with the assumption that the symptoms are real and that they have a cause.
Dr. Hirsch trained in complex spinal reconstruction at NYU Hospital for Joint Diseases, caring for patients with disabling deformities and extensive prior surgical histories. Revision cases require a different level of planning, judgment, and technical precision than primary surgery.
A Word About Failed Back Surgery Syndrome
Patients who still hurt after spine surgery are often given the label failed back surgery syndrome. It is a hard phrase to hear. It sounds like a judgment, and it explains nothing.
The label means only that symptoms continued after an operation. It says nothing about the reason. Two patients can carry the same label and have entirely different problems. The original problem can return. A new problem can develop at another level. The symptoms may be coming from a structure outside the spine. In some cases the operation was appropriate, it was done well, and the underlying condition continued to progress. These situations are unrelated to one another. Each one calls for a different approach.
The word failed suggests that a mistake was made. Usually that is not what happened. Most patients in this position followed the advice of a physician they trusted. Their symptoms are real and their case is not closed.
Much of the field has moved away from the term for these reasons. Some physicians still use post-laminectomy syndrome. Others have proposed persistent spinal pain syndrome, which describes what a patient is experiencing without assigning blame for it.
Whatever the label, the symptoms have a cause. Finding it takes an unhurried look at what was done before, what the imaging shows now, and the history behind both.
Common Revision Scenarios
Another Operation Is Not Always the Answer
Not every patient with pain after spine surgery needs more spine surgery. Some do. Some have a problem that is better treated without an operation. Some have symptoms coming from a source that surgery cannot reach.
Saying so is part of the evaluation. A recommendation against surgery is still an answer, and it is often the right one.
Technique
When a revision operation is indicated, the approach depends on the problem. Recurrent disc herniation and nerve compression next to a prior fusion can often be treated with endoscopic technique. Endoscopic spine surgery is an ultraminimally invasive approach that places a high-resolution camera inside the spine through a dime-sized incision, allowing the surgeon to work directly at the source of the problem without disturbing more of the spine than necessary.
Not every revision case is suited to an endoscopic approach. Some problems, including certain non-unions and alignment problems, are addressed with other minimally invasive techniques. Others call for a more traditional open procedure. The technique follows from the problem and from the patient's anatomy, and that determination is made case by case.
Dr. Hirsch takes the least invasive approach that reliably solves the problem.
Start With a Clear Read of What Was Done
If you have had prior spine surgery and continue to have symptoms, the first step is a careful review of your operative reports, your imaging, and your history.
Dr. Hirsch is board-certified and Yale-trained. Read his full background.
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