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The multiply operated lumbar spine.

S W Wiesel

    Instructional Course Lectures
    |January 1, 1985
    PubMed
    Summary

    Evaluating patients with multiple spine surgeries requires a systematic approach. Repeat surgery is only advised with objective findings, avoiding exploratory procedures to prevent further disability.

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    Area of Science:

    • Orthopaedic Surgery
    • Neurosurgery
    • Spinal Surgery

    Background:

    • Patients with multiply operated spines present complex diagnostic and therapeutic challenges.
    • Previous surgical decisions significantly influence outcomes in revision spinal surgery.
    • A thorough, organized evaluation is crucial for successful management.

    Purpose of the Study:

    • To outline a structured approach for evaluating patients with multiply operated spines.
    • To emphasize the importance of objective findings before considering further surgery.
    • To guide clinicians in differentiating mechanical issues from arachnoiditis.

    Main Methods:

    • Comprehensive patient assessment including orthopaedic, psychological, and general medical status.
    • Detailed analysis of clinical history (previous operations, pain characteristics) and physical examination (neurologic findings, tension signs).
    • Integration of imaging studies: plain roentgenograms, motion films, metrizamide myelography, and computerized axial tomography (CAT).

    Main Results:

    • Accurate localization and identification of the pain source are paramount.
    • Key historical points include the number of prior surgeries and pain distribution.
    • Objective findings from history, physical exam, and imaging are essential for surgical indication.

    Conclusions:

    • Exploratory surgery on multiply operated spines is contraindicated and leads to increased disability.
    • Repeat surgery requires a novel surgical approach, addressing potential dural tears.
    • Careful patient selection and surgical planning are critical for managing complex spinal cases.

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