Revision Spine Surgery

Revision spine surgery requires a unique skill set different from performing a primary operation. Understanding when a simple revision is sufficient, when a more complex approach is needed, or when a non-surgical option should be considered is critical to good patient care and outcomes. In this first book to focus exclusively on the complex topic of revision spine surgery, world-renowned Dr. Alex Vaccaro and leading neuro and orthopaedic spine surgeons, navigate physicians through the initial evaluative process and the potential pitfalls and complications encountered in revision surgery.

Table of Contents

GENERAL. The approach to revision procedures. How to dissect the plane between the scar of a laminectomy defect in the posterior cervical spine. How to dissect the plane between the scar of a laminectomy defect in the posterior thoracic and lumbar spine. Local muscle flaps in the setting of revision spine surgery: Indications, operative planning, principles, and postoperative management. Revision and reimplantation of a spinal cord stimulator device. ANTERIOR CERVICAL. Revision ACDF at the same level. Revision ACDF: Adjacent level. Converting a total disc replacement to an ACDF. Treatment of adjacent segment disease after total disc replacement (TDR). POSTERIOR CERVICAL. Revision suboccipital decompression for complex Chiari malformation. How to revise a failed occipital cervical fusion. How to revise a failed C1–C2. fusion. Treatment of postlaminectomy kyphosis. Revision of failed posterior cervical fusions. Complications necessitating surgical intervention following cervical laminoplasty. THORACIC/THORACOLUMBAR SPINE. Revision surgery for proximal junctional kyphosis following thoracolumbar fusion. Pedicle subtraction osteotomy (PSO) nonunion revision. Treatment of a nonunion of a thoracolumbar deformity, not at the site of a three-column osteotomy. How to safely remove a pedicle screw abutting the aorta. LUMBAR SPINE. Revision of an anterior lumbar interbody fusion (ALIF) nonunion. How to revise nonunion of a lateral lambar interbody fusion (LLIF) through a lateral approach. How to surgically manage a recurrent lumbar herniated nucleus pulposus (HNP). How to perform revision lumbar decompression. How to perform revision lumbar decompression at the index level through a minimally invasive (MIS) approach. How to revise a transforaminal lumbar interbody fusion (TLIF) nonunion with recurrent stenosis at the index level (open). How to revise a minimally invasive transforaminal lumbar interbody fusion (MIS TLIF) nonunion with recurrent stenosis at the index level through an MIS approach. How to revise a posterior lateral decompression and fusion at the index level. How to revise a posterior lumbar fusion that has developed adjacent-level stenosis with or without instability. Flat back deformity revision surgery. Revision high-grade spondylolisthesis surgery. Management of a ventrally displaced graft following ALIF, TLIF or DLIF. SPECIAL CASES. Treatment of symptomatic cervical and lumbar pseudomeningocoeles. Treatment of a persistent cervical dural tear. Treatment of a ventral thoracic dural defect. Treatment of a persistent lumbar dural tear. Treatment of a chronic postoperative cervical and lumbar spine infection.

Alexander R. Vaccaro, MD, PhD, MBA, graduated Summa Cum Laude from Boston College in 1983 with a B.S. in Biology. He received his M.D. degree from Georgetown University School of Medicine where he was promoted with “Distinction.” He earned membership in the Alpha Omega Alpha (AOA) Honor Society and graduated with honors in 1987. He completed a year of Surgical Internship at Cedars-Sinai Medical Center in Los Angeles, CA and his Orthopaedic Surgery Residency at Thomas Jefferson University where he graduated in 1992. Dr. Vaccaro completed a Spine Fellowship at the University of San Diego, CA. He earned a PhD in 2007 in the field of Spinal Trauma. He is the Richard H. Rothman Professor and Chairman, Department of Orthopaedic Surgery and Professor of Neurosurgery at Thomas Jefferson University in Philadelphia, PA.

He was the recipient of the Leon Wiltse award given for excellence in leadership and clinical research for spine care by the North American Spine Society (NASS) and is the past President of the American Spinal Injury Association and current President of the Association for Collaborative Spine Research. He has over 530 peer reviewed and 195 non-peer reviewed publications. He has published over 300 book chapters and is editor of over 44 textbooks and co-editor of OKU-Spine I and editor of OKU-8. Dr. Vaccaro is the President of Rothman Institute, Chairman of the Department of Orthopaedic Surgery, Co-Director of the Regional Spinal Cord Injury Center of the Delaware Valley and Co-Director of Spine Surgery and the Spine Fellowship program at Thomas Jefferson University Hospital where he instructs fellows and residents in the diagnosis and treatment of various spinal problems and disorders.

Ali Baaj, MD is a neurosurgeon who specializes in spinal surgery, with advanced training and expertise in spinal oncology and complex reconstructive surgery for spinal deformity, and both minimally invasive spinal surgery and open complex spine surgery. Before joining the faculty at Weill Cornell, Dr. Baaj served as the director of the Spinal Neurosurgery Program at the University of Arizona at Tucson, where he led the clinical program and founded the multidisciplinary spine conference and spinal research fellowship program. Dr. Baaj was the neurosurgery faculty recipient of the Humanism in Medicine award in 2013 and 2014 while at University of Arizona. Dr. Baaj earned both Bachelor’s and Master’s degrees from Boston University before receiving his M.D. from Boston University College of Medicine in 2004. He completed a general surgery internship at Johns Hopkins University in Baltimore, followed by a neurosurgical residency at the University of South Florida in Tampa. Dr. Baaj received further training as a Research Fellow at the Spinal Biomechanics Laboratory at Barrow Neurological Institute in Phoenix and as a Complex Spine Fellow at Johns Hopkins, with an emphasis on advanced techniques in spinal tumor resection and spinal reconstruction. He also completed a two-month traveling fellowship in Paris studying advanced techniques for pediatric deformity and scoliosis, with an emphasis on neuromuscular and idiopathic scoliosis. He is the lead editor of the best-selling, Handbook of Spine Surgery, now in its 2nd edition.

Gregory D. Schroeder, MD is Assistant Professor in the Department of Orthopaedic Surgery at Thomas Jefferson University in Philadelphia, Pennsylvania. He completed a two-year spine surgery and clinical research fellowship at the Rothman Institute at Thomas Jefferson University. He completed his orthopedic surgery residency program at Northwestern University in Chicago, and holds a Doctor of Medicine from Georgetown University School of Medicine