Revision spine surgery can be nightmarish for some patients. The need for revising an earlier operated spine can be; first, a new pathology at a new region has surfaced up, medically called adjacent segment disease when it occurs in the vicinity of previously operated spine; the second and the more dreadful one is when the primary surgery is to be redone as it failed to give the desired outcome. Medically, this is called failed back syndrome.
It takes a massive leap of faith on the patient's part to forget what happened and get ready for the other shot. The picture becomes cloudy when one looks at the literature putting odds of success and complications against the expectations. This is mostly attributed to the two facts: one is difficulty in pinpointing the root cause of the patient's problem and secondly, scar tissue from the previous surgery.
The first challenge of targeting the root cause has been accomplished by the combination of increasing the clinical experience of treating spine surgeons combined with the availability of imaging like 3T MRI, and imaging-guided nerve/disc blocks and nerve diagnostics like NCS/EMG. This has handled the menace of misdiagnosis in the spine and has significantly brought down the number of failed back surgeries.
Next challenge is operating through the scar tissue. Surgeries are based upon anatomical reproducibility. Any surgery through any part of body results in the replacement of typical structures with the scars, and scars do not have any anatomy. They are irregular, inconsistent and unreliable. Scar tissue makes it almost impossible to distinguish between various tissues like ligament, nerves, muscle and dura. The already complex anatomy of the spine area is further complicated by the presence of a scar, which diminishes anatomical reliable and thus, shoots up complication rates.
The Spine Team of Narayana Health North India, comprising Dharamshila Narayana Superspeciality Hospital, Delhi and Narayana Superspeciality Hospital, Gurgaon, has developed a three-pronged approach to deal with this. First, they bring down the tendency of scar formation by using minimally invasive techniques of spine surgery, causing minimal tissue damage. Secondly, anti-adhesive agents are used during the operation to bring down the rate of scarring near critical structures like nerve and dura. So finally doctors use the 3D navigation technology to navigate through the scar tissue. They use the tracking probe to orient themselves in the 3D anatomy. This keeps them oriented about the location of critical structures like nerves and dura, and thus, helps the doctors to dissect through scar tissue.
The Spine Team of Narayana Health North India, comprising Dharamshila Narayana Superspeciality Hospital, Delhi, and Narayana Superspeciality Hospital, Gurgaon, being a tertiary Centre, performs many revision spine surgeries.
With the help of strategy as mentioned above, the doctor claims to be able to bring success into it and complication rates in revision spine surgeries at par with the primary surgery. For those contemplating a revision spine surgery, the doctor recommends consulting spine consultant and seeking an expert treatment plan.
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