Revision Spine Surgery: Fixing a Failed L2-S1 Fusion

A failed spinal fusion can come back in more than one way at once. David was 49 and had already had three spine surgeries when he came to us, with back pain, weakness in both feet, and an L2 to S1 fusion with cages at every level. His X-rays showed a flat spine, shadow around the cages and screws, and one set screw backed out. The CT confirmed a pseudarthrosis at L5/S1 and L2/3, loose S1 screws, and adjacent segment disease above the fusion. We walk through the plan: an ALIF at L5/S1 with a wider cage, a laminectomy and extension up to T12, and larger screws throughout. Three weeks later David called, barely able to walk. He had fractured through the front of the sacrum, something we had never seen before. Going back in from the front was too dangerous at that point, so we revised him all posterior with four rods and four pelvic screws. Six months out, his CT shows he has fused. If you have had a fusion that did not heal, hardware that has loosened, or you are being told you need a revision, this is the kind of thinking that goes into it. Chapters: 0:00 Failed spinal fusion after three prior surgeries 0:58 Pseudarthrosis and adjacent segment disease on the X-ray 2:18 CT scan findings: loose pedicle screws and a fusion that never healed 3:43 ALIF revision at L5/S1 4:44 Extending the fusion to T12 for adjacent segment disease 6:59 Sacral fracture three weeks after surgery 9:09 All-posterior revision with four rods and pelvic screws To learn more about your spine condition or to schedule a consultation, see the link in my bio.