Understanding Revision Discectomy

Spinal disc herniation, commonly referred to as a slipped disc, is a painful condition that affects millions of people worldwide. It occurs when the soft cushion-like discs between the vertebrae of the spine bulge or rupture, leading to symptoms such as back pain, leg pain, numbness, and weakness. Discectomy is a surgical procedure often used to treat herniated discs, and revision discectomy is a subsequent surgery performed when the initial discectomy fails to provide relief or when the herniation recurs. This article explains what revision discectomy is, when it may be needed, and how it can be beneficial for patients.

Revision Discectomy Defined

When Is Revision Discectomy Needed?

• Recurrence of herniation – In some cases, the herniated disc may reoccur or bulge again after the initial surgery, leading to the return of symptoms.
• Disc degeneration – The disc may have degenerated further, leading to instability, narrowing of the spinal canal (spinal stenosis), or bone spurs (osteophytes) that irritate the nerves or spinal cord.
• Residual disc fragments – During the initial discectomy, it is possible that not all of the herniated disc fragments were removed. These remaining fragments can cause persistent symptoms and may require revision discectomy for complete removal.
• Scar tissue formation – After the initial discectomy, scar tissue may form around the surgical site, which can compress nerves and cause symptoms to persist.
• Failed fusion – In cases where the initial discectomy was combined with spinal fusion surgery, the fusion may not have properly healed or fused, leading to the recurrence of symptoms. 
• Post-surgical complications – Complications such as infections, hematomas, or nerve damage may occur after the initial discectomy surgery, leading to persistent pain and requiring revision surgery.

Benefits of Revision Discectomy

• Pain relief – Revision discectomy can address the underlying cause of persistent pain, such as remaining disc material or scar tissue, resulting in increased pain relief and better functional outcomes.
• Minimally invasive approach – Revision discectomy can often be performed using minimally invasive techniques such as microdiscectomy, which typically result in smaller incisions, less scarring, and quicker recovery times compared to open surgeries.
• Reduced need for opioids – Successful revision discectomy can reduce the need for long-term opioid use, which can be a concern for patients with chronic pain.
• Improved quality of life – Relief from persistent pain can significantly improve a patient's wellbeing, allowing him or her to return to normal activities and enjoy a better overall quality of life.
• Correcting surgical errors – In cases where the initial discectomy surgery was performed for the wrong diagnosis or at the wrong disc level, revision discectomy can correct the error and provide appropriate treatment for the underlying condition.

Revision Discectomy Procedure 

• Preoperative evaluation – Before undergoing revision discectomy, the patient will undergo a thorough evaluation, including a physical examination, imaging studies such as an MRI or CT scan, and a review of the patient's medical history.
• Incision – The surgeon will make an incision in the back over the affected disc space to gain access to the spine.
• Removal of scar tissue or residual disc fragments – The surgeon will carefully remove any scar tissue or remaining disc fragments that may be compressing the nerves and causing symptoms.
• Assessment of spinal stability – If the initial discectomy was combined with spinal fusion, the surgeon will assess the stability of the spine and may perform additional fusion procedures if necessary.
• Closure – Once the revision discectomy is complete, the surgeon will close the incision using sutures or staples, and a dressing will be applied.

Risks and Complications of Revision Discectomy 

• Bleeding
• Infection
• Nerve injury
• Spinal cord injury
• Dural tear (leakage of cerebrospinal fluid)
• Recurrence of disc herniation or bulging
• Failure of fusion
• Pseudarthrosis (nonunion of bone grafts)
• Hardware failure or loosening
• Adjacent segment degeneration (worsening of disc condition above or below the fused level)
• Chronic pain
• Reduced mobility

Recovery Following Revision Discectomy 

• Stay in the hospital for one to three days after the surgery
• Wear a brace or collar to support and protect the spine for several weeks
• Take pain medications and antibiotics as prescribed by the doctor
• Avoid bending, twisting, lifting, or driving for six to eight weeks
• Gradually resume normal activities and exercises as advised by the doctor and physical therapist
• Attend regular follow-up visits and imaging tests to monitor the healing and fusion of the spine

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