redo a imperfect surgery

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  • ThikAche
    Participant
    Post count: 11
    #25569 |

    I had an ACDF done two months back (Allograft was used). I am having a lot of pain and a CT scan found that sharp osteophyte causing foraminal stenosis and may be some root nerve stenosis. One surgeon has recommended a redo. These are the tough questions

    1) Is it too risky to open the plate from the two month old surgery. There are signs of fusion on all the levels.
    2) Is it very risky to drill the allograft to reach the osteophyte behind? (as opposed to disc). There are signs of fusion.
    3) Because there is no new level an ideal access point can be the old scar. Is it too risky to use the old scar? or should the surgeon use a new incision on the other side?

    Any suggestion and recommendations are appreciated.

    • This topic was modified 4 months ago by  ThikAche.
    Dr. Corenman
    Moderator
    Post count: 5543

    First is that you have to prove the diagnosis before you plan on a revision surgery. Is the physical exam and history consistent with the diagnosis? You then need a selective nerve root block (SNRB) with appropriate relief ( see pain diary).

    If all the stars align, a revision would be appropriate. Since the spur originates from the front (anterior), I would advise a revision from the front. There is no problem taking down a fusion and revising the decompression. At two months with an allograft, there should be no issues.

    The old scar is exactly where the new incision should be. Scar should be easily dealt with and the approach is straight forward

    Dr. Corenman

    PLEASE REMEMBER, THIS FORUM IS MEANT TO PROVIDE GENERAL INFORMATION ON SPINE ANATOMY, CONDITIONS AND TREATMENTS. TO GET AN ACCURATE DIAGNOSIS, YOU MUST VISIT A QUALIFIED PROFESSIONAL IN PERSON.
    If this forum has helped you, please let Dr. Corenman know!

    ThikAche
    Participant
    Post count: 11

    I really appreciate it. I am guessing by the time diagnosis is complete and insurance approval happens it will be more than two months. It just takes a lot of time between two appointments.

    Dr. Corenman
    Moderator
    Post count: 5543

    I understand the appointment delays. Even if the graft fully incorporates, a revision is still not that hard to perform surgically.

    Dr. Corenman

    PLEASE REMEMBER, THIS FORUM IS MEANT TO PROVIDE GENERAL INFORMATION ON SPINE ANATOMY, CONDITIONS AND TREATMENTS. TO GET AN ACCURATE DIAGNOSIS, YOU MUST VISIT A QUALIFIED PROFESSIONAL IN PERSON.
    If this forum has helped you, please let Dr. Corenman know!

    ThikAche
    Participant
    Post count: 11

    Initial surgery had the posterior longitudinal ligament ripped off. Does it make the redo from the front harder? The debris (when drilling the allograft) will go on the dura?

    Dr. Corenman
    Moderator
    Post count: 5543

    Taking off the PLL from the prior surgery does make surgery slightly more challenging but the principle is still the same. Debris will easily be suctioned out.

    Dr. Corenman

    PLEASE REMEMBER, THIS FORUM IS MEANT TO PROVIDE GENERAL INFORMATION ON SPINE ANATOMY, CONDITIONS AND TREATMENTS. TO GET AN ACCURATE DIAGNOSIS, YOU MUST VISIT A QUALIFIED PROFESSIONAL IN PERSON.
    If this forum has helped you, please let Dr. Corenman know!

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