Causes of Failed Spine Surgeries
Failed spine surgeries have been increasing significantly in recent years. The main reasons include improper patient selection, incorrect surgical technique, incorrect level selection, and patient-related factors.
1. Improper Patient Selection
Improper patient selection often occurs in cases involving patients with numerous comorbidities, morbid obesity, poor bone quality, or those who could potentially recover with non-surgical methods, as well as patients who are not psychologically suited for surgery. In most surgical procedures, anatomical and physiological abnormalities can arise in the patient's spine. Therefore, surgical techniques that cause minimal damage to the anatomy should be chosen.
2. Selection of Surgical Technique and Level
However, this is not always possible for every patient. While minimally invasive procedures may be sufficient for some patients, extensive surgeries involving multi-level implants may be necessary for others. The choice of surgical technique may also vary depending on the surgeon’s experience. What’s most important is to assess the best surgical option for the patient and discuss the treatment plan in detail with them.
3. Unnecessary Implant Use and Incorrect Level Selection
The use of unnecessary implants, the implantation of incorrect levels, inadequate restoration of the physiological curvature of the spine, or the insufficient number of vertebrae being treated often result in revision surgeries. Patient-related factors can also lead to revisions, including advanced osteoporosis, morbid obesity, rheumatic diseases, prolonged use of corticosteroids, smoking, alcohol consumption, and radiotherapy in oncology patients.
4. Post-Surgical Assessment
Regardless of the reason, patients experiencing persistent or worsening pain, weakness, or wound complications after surgery should be re-evaluated with detailed imaging techniques to identify any potential surgical complications.
5. Most Common Reasons for Revision Surgeries
Revision surgeries are most frequently performed following repeated lumbar disc surgeries. If a disc herniation recurs at the same level, simple discectomy may be attempted again, but stabilization surgeries, where vertebrae are fixed with screws, are usually necessary.
6. Implant-Related Revisions
The most common reason for implant-related revisions is complications arising from a lack of fusion. These usually present as breaks in the metal rods or loosening of screws, leading to increased pain. In such cases, careful planning for revision surgery is essential, opting for techniques that enhance fusion rates. This often involves placing cages—titanium blocks designed to bear the load—at the front of the vertebrae to support the spine and reduce the stress on screws. These can be placed through small incisions in the abdominal wall or from the back where the screws were initially inserted. Cages placed from the front have a larger surface area and height, providing several advantages over those inserted from the back.
Early Revision Surgeries
One of the early revision surgeries commonly observed is due to proximal junctional kyphosis (PJK) that occurs just above the top screw after long-level instrumentation in elderly patients. If PJK becomes severe and the patient's pain is significant, the instrumentation must be extended to the stable vertebra above. Additionally, to prevent recurrence of PJK, the bone quality in these patients should be improved through medical treatments.
Flat Back Syndrome
Another common reason for revision surgeries is the development of flat back syndrome due to insufficient lumbar lordosis provided to the patient. Patients with inadequate lumbar curvature may experience difficulty in standing upright and suffer from early fatigue in the back and lumbar muscles, leading to reduced activity levels. Revision surgery should be planned and performed by experienced spine surgeons. Each patient has a unique lumbar curve angle. This angle should be determined using special measurement methods, and the most optimal lumbar curvature should be provided during the surgery.