[Review of surgical cases which have deteriorated over time]

Revision for unacceptable outcomes of surgical spine treatment is not uncommon. As a result of extended life expectancy a new group of patients have expectations for full range of activities in spite of an ongoing degenerative spine process. The higher standards of this population coupled with less tolerance toward pain and deformities, no longer well tolerated in the Accident resulted in increased demand for surgical treatment. Instruments and techniques having been refined in the last 30 years have greatly improved the treatment and surgical outcome of spine deformity and spine degeneration however in spite of a better understanding of spine biomechanics progress often came via trial and error. The study presented here is based upon 154 patients, adolescents and adults who underwent revision surgery for a host of problems related to malalignment, instability or a combination of both. 102 presented decompensations after scoliosis surgery and 52 older adults presented a "failed back". Surgical revision is intrusive, requiring osteotomies often via anterior and posterior approaches with implantation of new instrumentation aiming for a solid arthrodesis. All complications of this revision surgery totaled 23%. Results at 5 year 8 months follow up show a 78% patient's improvement. The learning points from this experience are to give priority to spine balance and junctional zones in planning primary or revision surgery. It is important to recognize the place of preventive realignment to prevent further fusion extension to the cervical spine or at the opposite side of the spectrum further extension to the sacrum.