title: Rationale of revision lumbar spine surgery.
abstract: Revision lumbar spine surgeries are technically challenging with inconstant outcome results. This article discusses the preoperative, intraoperative, as well as postoperative management in these difficult patients. Successful intervention requires a detailed history and physical examination and carefully chosen diagnostic tests. Preoperative planning is paramount in these cases. The decision-making process should address the timing of the surgery, surgical approach, level of interbody fusion required, correction of sagittal imbalance, type of osteotomy, location of the osteotomy, and the end of the construct. Surgeons should be prepared to manage associated complications such as dural tear and massive blood loss. The use of autograft and/or biologic graft is necessary to help in achieving a successful fusion. Postoperative management includes prophylactic antibiotic, anticoagulation, nutritional support, and brace.
authors.affiliation: Department of Orthpaedics, University of Toledo Medical Center, Toledo, Ohio.
authors.forename: Hossein
authors.initials: H
authors.lastname: Elgafy
authors.affiliation: Department of Orthopaedics, Thomas Jefferson University and the Rothman Institute, Philadelphia, Pennsylvania.
authors.forename: Alexander R
authors.initials: AR
authors.lastname: Vaccaro
authors.affiliation: Department of Orthopaedics, University of Washington School of Medicine, Seattle, Washington.
authors.forename: Jens R
authors.initials: JR
authors.lastname: Chapman
authors.affiliation: Department of Orthopaedics, University of British Columbia, Vancouver, Canada.
authors.forename: Marcel F
authors.initials: MF
authors.lastname: Dvorak
keywords: intraoperative strategies; lumbar spine; postoperative management; preoperative evaluation; revision