Revision of surgical cases which have deteriorated in time

Revision for unacceptable outcomes of surgical spine treatment is not uncom mon. As a result of extended life expectancy a new group of patients have e xpectations for full range of activities in spite of an ongoing degenerativ e spine process. The higher standards of this population coupled with less tolerance toward pain and deformities, no longer well tolerated in the Occi dent resulted in increased demand for surgical treatment. Instrumentations and techniques having been refined in the last 30 years have greatly improv ed the treatment and surgical outcome of spine deformity and spine degenera tion however in spite of a better understanding of spine biomechanics progr ess often cae via trial and error. The study presented here is based upon 1 54 patients, adolescents and adults who underwent revision surgery for a ho st of problems related to malalignment, instability or a combination of bot h. 102 presented decompensations after scoliosis surgery and 52 older adult s presented a << failed back >>. Surgical revision is intrusive, requiring osteotomies often via anterior and posterior approaches with implantation o f new instrumentation aiming for a solid arthrodesis. All complications of this revision surgery totaled 23%. Results at 5 year 8 months followup show a 78% patient's improvement. The learning points from this experience are to give priority to spine balance and junctional zones in planing primary o r revision surgery. It is important to recognize the place of preventive re alignment to prevent further fusion extensin to the cervical spine or at th e opposite side of the spectrum further extension to the sacrum.