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Adult Spinal Deformity Surgery
Revision Adult Deformity Surgery
An in-depth, evidence-based explanation of revision surgery for adult spinal deformity — correcting problems that develop after previous deformity or fusion surgery.
Revision adult deformity surgery is surgery to correct problems that arise after a previous deformity or fusion operation. Long fusions carry recognised long-term risks, and sometimes the spine breaks down above a fusion, the fusion fails to knit, metalwork loosens or breaks, or the overall balance decompensates over time. Revision surgery aims to put these problems right — re-establishing balanced alignment, achieving a solid fusion and relieving symptoms. It is demanding surgery, planned carefully around what has gone before, and this page explains when it is considered and what it involves.
For information only — not medical advice. The content on this page is patient education to help you understand a condition or treatment. It is not a substitute for personalised assessment by a qualified clinician. Always consult your doctor or specialist about your own symptoms, diagnosis, and treatment decisions.
Why revision is sometimes needed
Even well-performed deformity surgery can develop problems years later, and the commonest reasons for revision are well described. The junction just above a long fusion can break down into a kyphosis (proximal junctional kyphosis) or fail more severely; the fusion may not knit solidly (pseudarthrosis), which can cause pain and rod fracture; implants can loosen; and the spine can gradually fall out of balance again. Recognising which of these is driving the symptoms is the key first step, because the right revision depends on the exact problem.
What revision surgery involves
Revision is individualised to the underlying problem. It may involve extending a fusion to rescue a failing junction, re-doing or reinforcing a fusion that has not knitted, exchanging or adding metalwork, and — where the spine has fallen out of balance — realigning it, sometimes with osteotomies to rebuild the sagittal shape. Because the tissues and anatomy have been altered by previous surgery, revision is technically more challenging and is planned meticulously, with attention to bone quality, the length and endpoints of the construct, and protecting the nerves throughout with monitoring.
What the evidence shows
The evidence is honest about both the need for, and the challenges of, revision. Large prospective adult deformity databases document meaningful reoperation rates and their impact, and studies of proximal junctional kyphosis and of pseudarthrosis in long fusions to the sacrum identify who is most at risk and why. This literature guides both prevention — through careful planning of the original construct — and the strategy for revision when it is needed. The balanced view is that revision deformity surgery is worthwhile for the right problem, but it is major surgery and the decision is carefully individualised.
What to expect
Revision surgery is carried out under general anaesthetic, usually with a hospital stay of several days and a recovery measured in months, supported by rehabilitation. The metalwork provides immediate stability while the revised fusion consolidates. Because these are complex operations in altered anatomy, the risks are discussed frankly beforehand, and medical optimisation and good bone health are important to a durable result. The right revision strategy for a given person is decided together.
The information provided on this page is intended for educational purposes only and should not be considered personalised medical advice. Every patient is different, and treatment options, risks, expected recovery and outcomes depend upon an individual's diagnosis, previous surgery, general health and personal circumstances. Decisions regarding treatment should always be made following consultation with your treating spinal surgeon or healthcare professional.
Evidence & further reading
- —Scheer JK, et al. Reoperation rates and impact on outcome in a large prospective multicentre adult spinal deformity database. J Neurosurg Spine 2013. (PMID 23971763)
- —Smith JS, et al. Prospective multicentre assessment of perioperative and minimum 2-year complication rates in adult spinal deformity surgery. J Neurosurg Spine 2016. (PMID 26918574)
- —Kim YJ, et al. Pseudarthrosis in long adult spinal deformity fusion to the sacrum: prevalence and risk factors. Spine 2006. (PMID 16985461)
- —Glattes RC, et al. Proximal junctional kyphosis following long instrumented posterior spinal fusion. Spine 2005. (PMID 16025035)
- —Yagi M, et al. Incidence, risk factors and classification of proximal junctional kyphosis in adult scoliosis. Spine 2011. (PMID 21192216)
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