Spine revision surgery is performed when a patient has undergone a previous back surgery that has proved unsuccessful, resulting in new or recurring pain.

Dr. Shiveindra Jeyamohan, a neurosurgeon with the EvergreenHealth Neuroscience, Spine & Orthopedic Institute, explains how to know if you might need this procedure.

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What makes an initial spine surgery unsuccessful?
Are there certain surgery approaches that require revision surgeries more often than others?

Dr. Shiveindra Jeyamohan:  Spine surgery is a continuously evolving field and new research comes out every day.

In the 1980’s and 1990’s, many patients received spinal fusions hoping it would alleviate their back pain.

Unfortunately, it often did not work out that way, and some patients have come to find that the fusion now puts increased stress at the levels above and below the surgery, making these discs and joints break down faster, causing new painful symptoms.

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Why does this happen?

Dr. Jeyamohan:  Our spine is naturally built with an almost artistic curve. In addition to looking picturesque, this curve has a lot of function. It allows us to keep our head over our shoulders, shoulders over our hips, and hips over our feet.

Many spinal fusions performed in the past have affected or thrown off this curve, affecting patients’ balance, and making muscles work hard to keep their bodies upright.

As we age, and these muscles wear down, as well as our spines, it becomes more painful to stand and walk upright. “Flatback” as this has been referred, to is now a well-studied phenomenon, and surgery can help.

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How do I know if I need spine revision surgery; what are the symptoms?

Dr. Jeyamohan:  Symptoms typically develop over many years. The most common include:

• New and radiating pain in arms or legs
• Numbness, tingling, burning, or stabbing sensations in arms or legs
• Weakness in arms or legs
• Issues with continence or numbness in the genitals (this is an EMERGENCY and needs immediate medical attention)
• Difficulty walking, difficulty using hands, problems with dexterity, dropping things frequently
• Pain, cramping, numbness, tingling with walking, improves with rest

Arthritis can certainly cause pain as a separate health concern. However, fusions that put increased stress above and below the level of fusion accelerates arthritis.

Everyone is unique and everyone’s pattern of arthritis is different, though the patterns themselves are predictable: disc degenerates, facets become large and ligaments become thick.

Some patients come back for an appointment one to two years after spine surgery with symptoms presenting, whereas others are comfortable with a “check in” ten years later, and are feeling fantastic.

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When should I see a doctor?

Dr. Jeyamohan:  You should see a doctor when:

• Your symptoms are not controlled with conservative measures
• If you have worsening weakness or pain
• f you have trouble walking
• If you experience numbness in your genitals, or have accidents voiding without realizing it (urine or stool). See a health care provider right away if you experience this symptom.

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