Revision Spine Surgery for Pediatric Patients

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For children with spinal deformities, surgical intervention can lead to life-altering improvements in pain relief, daily functioning, and cosmetic appearance. In fact, statistics show that with proper screening, the majority of children do well after undergoing surgery to correct a spinal deformity. However, for a relatively small percentage of young patients, additional surgery may be required in order to address painful symptoms, a deformity that continues to progress, or to maintain the child’s growth potential.

Minors

A number of factors may contribute to the need for revision surgery, including:

Pseudarthrosis, or a non-union of the bone, following a spinal fusion
Crankshaft phenomenon: in which the posterior column of the spine is fused, and the anterior column continues to grow and “rotate” around the fused area
Junctional degeneration: damage to the spine (discs and vertebrae) that develops above or below the area that has been fused
Deformity progression (also known as “adding on”) in the sagittal and/or coronal planes of the spine
Infection in the bone or around instrumentation
Fixed sagittal imbalance (also called flatback): a condition in which too much of the natural sway in the lumbar spine has been eliminated
Pain associated with instrumentation, either due to prominence of the implanted instrumentation and tenderness, or related to infection
Broken implants requiring replacement

Imaging and Diagnosis

Imaging techniques used to assess patients with these symptoms include:

Standing X-rays as well as dynamic views (the patient is asked to bend side-to-side or forward and back) and oblique X-rays (with the view angled 45 degrees) that can help determine the presence of bone spurs or uncommon fractures
CT scans, which show more detail, helping to determine the position of instrumentation in the bone and status of the fusion
CT myelogram; a CT scan combined with a myelogram in which dye is injected into the spinal canal, highlighting soft tissues such as the spinal cord and nerve roots. A CT myelogram is used to show pressure on the spinal cord or nerve roots as well as swelling or inflammation

Treatment

Extension of a previous fusion to address degenerative changes above or below the original fusion site
Additional fusions using a combined surgical approach from the front (anterior) and back (posterior) of the spine
Osteotomies, a cut across a deformed segment of the spine to restore proper alignment
Removal and/or replacement of instrumentation
Debridement - removal of scar and devitalized tissue; often used along with antibiotic therapy to treat an infection

Our medical team

Our multidisciplinary and collaborative environment allows us to address your back condition with personalized recommendations and comprehensive treatment options for acute and chronic cervical, thoracic, and lumbar spine injuries. Correction of angular spinal deformities (scoliosis). Comprehensive treatment of low back pain (operative and non-operative management). Outpatient care and procedures for analgesic control (blocks).

Each member of the spine team focuses on improving your spine health, mobility and overall quality of life.