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Currently, in the high volume centers, spine and scoliosis surgery has a very high success rate using good indications, modern techniques, modern instrumentation, and focused medical management. However, many patients with a previously operated scoliosis or spine may have had an operation with an older technique, had a newly degenerative spine next to the previous operation, or fell in to the small percentage of patients who do not heal. These can be broken down into four general categories.
Flatback syndrome or imbalance. Historically, flatback syndrome referred to the use of a Harrington rod being used to treat a lumbar or double scoliosis. In this case, the distractive properties of the Harrington rod led to loss of lumbar lordosis. Patients initially did well, but as they aged, early spine degeneration, along with loss of hip range of motion, led to progressive stooping leading to an accelerated development of disability. Progressive stooping, back pain, and sometimes leg pain from bone spurs can be issues. These problems can form 10-50 years after the initial surgery.
More recently, flatback can occur from lumbar laminectomy or fusion surgery. In these cases the timeline is usually shorter. The other issues in previously operated spines can apply as well, such as non-union, and nerve pinching.
Non-Union. Using current techniques, chance of non union after a scoliosis or spine surgery is relatively low. However, older studies show it to be 10-30%. In these cases, either in the short term or long term, there can be pain, broken rods, progressive deformity, and new nerve pinching.
Nerve pinching/stenosis. In this situation, there is either residual nerve squeezing after the surgery or new nerve squeezing after the adjacent spine has degenerated.
Adding on, junctional syndrome: in any type of scoliosis surgery, the risk of a junctional syndrome is present. In some cases this risk is extremely small (1%) such as in a teenager or young adult with a single right thoracic curve. In other cases this is very high, due to lack of surgeon experience with level selection (Lenke 1AR curves) or difficult curve types (selective fusion in a Lenke 3C curve in a teenager or young adult or a realignment surgery such as a subtraction osteotomy in an osteoporotic patient). This risk can be minimized with the surgical experience, technique, and level choice of the physician and some medical management issues.
In each of the cases above, there are often conservative treatments to try as long as there is evidence for effectiveness and no risk of permanent damage. These include either therapy, bracing, or injections. If these fail, surgery may be necessary. The complexity of revision or repeat surgery necessitates that the surgeon make sure that the spine is aligned, the spine heals properly, and all neural elements are protected and decompressed. Experience in revision surgery, including scar dissection, revision reconstruction, and osteotomy surgery, is important in these patients.