Essentials of Revision Spine Deformity Surgery (Podcast)

Candidates for revision spine deformity surgery are typically patients who’ve had prior surgery for scoliosis or kyphosis or who develop iatrogenic deformity following an earlier spine surgery.

“Most patients who come to see us for these procedures are complaining of some sort of pain, sometimes accompanied by postural problems,” says spine surgeon Jason Savage, MD, Director of the Spinal Deformity Program in Cleveland Clinic’s Center for Spine Health. “It can be back pain, leg pain, sciatica pain or pain resulting from an inability to stand upright. I try to avoid revision deformity surgery when we can, because these can be big and complex operations, but if the patient’s symptom severity warrants it, we can offer solutions.”

In the latest episode of Cleveland Clinic’s Neuro Pathways podcast, Dr. Savage discusses these solutions along with various considerations around them and leading up to them. He explores the following aspects of revision spine deformity surgery, among other topics:

• Patient evaluation and surgical indications
• Diagnostic imaging and assessment
• The importance of preoperative patient optimization
• Surgical procedures and intraoperative considerations
• Postoperative care and complications
• Technological advances, including the evolution of robotic assistance and likely roles for artificial intelligence

Click the podcast player above to listen to the 29-minute episode now or read on for an edited excerpt. Check out more Neuro Pathways episodes at clevelandclinic.org/neuropodcast or wherever you get your podcasts.

This activity has been approved for AMA PRA Category 1 Credit™ and ANCC contact hours. After listening to the podcast, you can claim your credit here.

Excerpt from the podcast

Podcast host Glen Stevens, DO, PhD: What are some common pitfalls of revision deformity surgeries?

Jason Savage, MD: When I think of my practice over the past 13 years, the importance of doing preoperative planning really stands out. You have to get the preoperative optimization right. One of the pitfalls is not maybe focusing as much as needed on getting the patient’s bone health better prior to doing their deformity surgery. There’s nothing worse than doing what you think is a great operation on someone and thinking it’s really going to help them and then finding out later that their bone wasn’t strong enough and the screws pull out and they’ll need more surgery. That just opens up Pandora’s box.

I think another pitfall is making sure we get the correction right the first time. That means that whatever alignment goals you have during surgery, you have to make sure you achieve them. Because if you don't accomplish those goals, that sometimes sets people up for a risk of failure.

Dr. Stevens: Do you ever do staged procedures in these cases?

Dr. Savage: Sometimes we will, although not most of the time. Sometimes we’re doing anterior and posterior surgeries, anterior meaning we’re coming from the belly first. Sometimes we'll do procedures from the side to access the disc and then do posterior procedures. Most of the time, particularly in the thoracolumbar spine, we’ll do those as one-stage procedures. But for some of our complex cervical deformities, we will stage them, either doing the back part first and then the front part, or vice versa.