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I am so frustrated, I could scream. We went through months of agonizing decisions about our daughter who has a chromosomal defect and is severely handicapped. She had surgery to fuse her spine so she could breathe again. Now we find out she needs another operation to "revise" the first operation. Does this happen to everyone? Why don't they warn us this could happen?
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Modern medicine can perform many "miracles" these days. Among them is the ability to surgically straighten a spine that is severely curved from a childhood condition called scoliosis. Pediatric spinal deformities requiring surgery may also occur associated with other developmental problems, neuromuscular diseases, or genetic conditions such as your daughter has.
But a one-time procedure is unlikely over the lifetime of those children as they grow and move into and through adulthood. Revision surgery is required in up to one-fourth (25 per cent) of all cases. The reasons for revision spinal deformity surgery vary.
It could be there wasn't enough spinal correction the first time or there is a remaining imbalance in the spine that requires a two- or three-step series of operations. The fusion might not be complete and pseudoarthrosis (a false joint) develops. Loss of correction and an uncorrected second spinal curve getting worse may drive the decision to reoperate.
Sometimes the hardware (rods and screws) used to hold the spine in place break or get dislodged and must be repaired or removed and replaced. Revision surgery is needed then. If infection develops, the surgeon may have to go back in and perform additional procedures. And in some cases, the child or teenager develops pain at the operative site that must be investigated.
Whatever the reason, each case is unique and requires careful consideration and preplanning in order to gain a good result. Surgeons know this can be a very stressful time for the patient and the family. Many times the possibility of a revision surgery was discussed at the beginning (at the time of the first surgery). But there is so much information to take in that the family rarely hears that news.
When the decision is made to perform a revision procedure, the surgeon must plan carefully. Every effort is made to prevent further complications. Be prepared for some of the same decision-making steps that you went through the first time.
Preoperative imaging including X-rays and CT scans help the surgeon plan his or her correction strategy. CT scans are especially helpful in showing areas of infection or the presence of a pseudoarthrosis (false joint). Every angle and every level of the spine is taken into consideration during the pre-operative planning phase.
Everyone on the team (including you!) wants what's best for the child. Don't hesitate to express your frustration and ask any questions you may have. That is an important part of the process. And beware that on occasion, the revision surgery requires additional revisions (meaning possibly a third procedure).
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*Disclaimer:*The information contained herein is compiled from a variety of sources. It may not be complete or timely. It does not cover all diseases, physical conditions, ailments or treatments. The information should NOT be used in place of visit with your healthcare provider, nor should you disregard the advice of your health care provider because of any information you read in this topic. |
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