Who is a candidate?
This covers correction after previous surgery (non-united fusion, failed or prominent hardware, ongoing nerve compression, or degeneration at levels adjacent to an earlier fusion), and correction of adult deformity where alignment has deteriorated enough to affect standing, walking, or nerve function. There must be a clear, identifiable target; exploratory surgery in the hope of improvement is not offered.
How the procedure works
Planning is the largest part. Full-length standing X-rays define the alignment goal, CT assesses whether previous fusions have united, and MRI shows where nerves remain compressed. The operation may involve removing or extending previous instrumentation, decompressing nerves, releasing or cutting through fused segments to allow correction, and re-instrumenting across a longer construct. Where the construct requires it, fixation extends to the occiput above or the pelvis below.
Recovery
Recovery is longer than after a primary operation and depends on the extent of what was done. Mobilization begins as soon as it is safe, often with therapy support in hospital. Bracing is sometimes used. Bone healing across a long construct takes many months, and activity is advanced in deliberate stages with interval imaging.
Benefits and alternatives
The goal is to address a specific, identified problem, restoring alignment so standing takes less effort, relieving compressed nerves, or achieving union where a previous fusion failed. Alternatives include continued non-operative management with therapy, medication, and targeted injections, and more limited procedures where a focal problem can be addressed without a larger reconstruction.
Risks
Revision and deformity surgery carries higher risks than primary surgery: infection, significant blood loss, nerve or spinal cord injury, a tear in the lining around the nerves, hardware failure, non-union, and the possibility of further surgery. Longer constructs carry their own long-term considerations, including junctional problems at the ends. These are discussed in detail, with the expected benefit stated honestly, before any decision.