Revision Neck Surgery After Failed Back Surgery

If your cervical spine (neck) surgery did not produce the results you and your surgeon expected, your surgeon may initially recommend non-surgical treatments (eg, medications and physical therapy) to help ease your neck, shoulder, arm, and/or upper back pain and other symptoms related to failed back surgery syndrome. But, in rare cases, your surgeon may opt to perform a revision surgery (or second surgery) to treat failed back surgery (also known as FBS, failed back surgery syndrome, FBSS, and post-laminectomy syndrome).
 Patient and doctor reviewing x-ray, man holding his neck in pain.In rare situations, a second cervical spine surgery may be necessary to treat neck pain. Photo Source: 123RF.com.

The More Spine Surgeries, the Better?

After a receiving a diagnosis of failed back surgery, you may assume revision surgery is your only option. A revision surgery is generally less likely to help than the primary surgery. In fact, the more spine surgeries you undergo, the less likely they are to be successful. Sometimes FBSS is due to lack of attaining a fusion and therefore a second surgery to secure spinal fusion is necessary.

More than 50% of first spine surgeries are considered a success, but the success rates drop with each subsequent surgery:

  • Second spine surgeries have a success rate of 30%, at most.1
  • Third spine surgeries have a success rate of 15%, at most.1
  • Fourth spine surgeries have a success rate of 5%, at most.1

Each patient is unique and treatment options and results will vary.

When Is a Revision or Second Neck Surgery Considered?

Several factors will determine whether you are a candidate for a revision of a prior neck surgery, including:

  • Non-surgical therapies have not controlled your failed back surgery symptoms.
  • The buy-in of both you and your surgeon: You should understand the risks and benefits of undergoing a second neck surgery. To that end, you may need to complete a pre-surgery psychological assessment to gauge your readiness for surgery and suggest potential treatment for mental and emotional disorders (if needed) prior to surgery. Also, your surgeon must agree to perform the second surgery.

Additionally, you and your doctor may decide to pursue a revision neck surgery if you’ve developed any of the following conditions/spinal problems after your first neck surgery:

  • Your doctor has diagnosed you with a new spinal disorder (different from the diagnosis of your first neck surgery).
  • Your initial spinal diagnosis has returned (eg, cervical disc herniation, spinal stenosis)
  • You have cervical instability (potentially caused by the removal of too much bone during a decompression surgery) or pseudoarthrosis (a failed spinal fusion), which may require immediate surgical intervention.
  • You have a spinal infection (eg, post-operative infection, osteomyelitis), which may require immediate surgical intervention.
  • You’ve developed severe neurologic (nerve-related) symptoms (eg, weakness, numbness, tingling). In the neck, cervical myelopathy (spinal cord compression) is among the most severe forms of neurological deficit, and it may require immediate surgical intervention.
  • Spinal instrumentation problems, such as moved or broken hardware, causes extreme pain and the potential for nerve and/or vascular injury. This may require immediate surgical intervention.
  • You’ve developed scar tissue problems, such as epidural fibrosus (the formation of scar tissue around spinal nerve roots).
  • You have arachnoiditis.
  • You’ve developed adjacent segment disease after your first neck surgery.
  • Your initial neck surgery didn’t create enough space around compressed spinal nerves in your neck (inadequate neural decompression), resulting in continued nerve problems.

What’s the Purpose of a Revision Surgery After Failed Back Surgery?

Besides treating a specific cervical spine problem (eg, removing problematic spinal instrumentation), revision neck surgery after FBS usually involves:

  • Decompression – removing something pressing on the spinal cord or nerves
  • Stabilization – reducing movement of a disc space or joint to reduce to pain.
  • Both

Basics of decompression cervical spine surgery
During cervical spine decompression surgery, the surgeon either removes spinal structures (tissue, bone) that are pressing on spinal nerves, or he or she physically widens the area around the spinal nerve root.

Examples of decompression surgeries include:

  • Foraminotomy – removing bone and disc that presses on a nerve as it leaves the spinal canal either on the right or left side.
  • Laminotomy and laminectomy  - removing the midline area bone posteriorly and giving the central spinal canal more space.
  • Discectomy – removing the disc. In the cervical spine, discectomies are the most commonly done surgeries and typically done from the front.  Also known as an anterior cervical discectomy.

Basics of stabilization cervical spine surgery
The goal of stabilization spine surgery is to limit abnormal motion between spinal bones (vertebrae). When the vertebrae move more than they should, they can damage the spinal cord and other nerve structures—and this can cause serious complications (eg, paralysis). In the past when a disc was removed anteriorly, stabilization with a fusion surgery was required but now options include placement of an artificial cervical disc.

Sometimes, decompression surgeries can create instability because they create gaps in the spine that allow this extra movement. In these cases, your surgeon will perform a stabilization surgery—called a cervical spinal fusion—after the decompression. A fusion may include instrumentation (eg, screws, rods, plates) to support the fusion of one spinal bone to another and reinforce stability in the spine.

Where Will My Revision Neck Surgery Be Performed?

Advancements in spine surgery have enabled doctors to perform surgery outside of the traditional hospital setting. Surgeons often work out of more than one facility, so you may have options on where you have your revision neck surgery. If you have a choice of where to have your surgery, it’s worthwhile to ask which facility has the highest success rate for your failed back surgery revision procedure.

Your doctor may allow you to have your neck revision surgery in an outpatient spine center or ambulatory surgery center (ASC). These options are designed to be convenient and comfortable for patients, as they often don’t require an overnight stay.

Whether you have your neck procedure performed in a hospital or outpatient facility, it’s important to ask about what post-surgery pain management options you’ll have and whether an overnight stay will be necessary.

Get the Information You Need Before Your Revision Neck Surgery

Among the best ways to position yourself for surgical success is to know what to expect from your procedure and the recovery. If you need a revision neck surgery to treat your failed back surgery, asking as many questions as you can before your procedure will help ensure you have a clear understanding of the procedure. Here are some good examples:

  • Why do I need this type of neck surgery?
  • What outcomes should I expect from my surgery?
  • What’s the success rate of my revision neck surgery?
  • Are there any non-surgical treatments that I haven’t yet explored that I should try first?
  • What are the benefits and risks of having this neck operation?

Undergoing a revision neck surgery after failed back surgery (FBS) can be a daunting, frustrating experience. But keeping the communications lines open with your surgeon will help ensure that you’re on the same page and on the same team—and that can only improve your chances of success.

Updated on: 02/06/19
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