Second Surgery can Often Help "Failed Backs"Neurosurgeon and Orthopaedic Surgeon Work Together to Increase Likelihood of Revision Spine Surgery Success
William J. Sonstein, MD, FACS
ROCKVILLE, CENTRE, N.Y., November 11, 2010 – Back pain can sometimes return after spine surgery. While conservative approaches such as physical therapy are generally first line treatments for recurring back pain, a second surgery is sometimes necessary.
Reasons for recurring back pain after surgery are many. Scar tissue following surgery can cause pain, and proper tissue healing may not take place. Even after a successful surgery, the shape and function of the spine can deteriorate, requiring further surgery. In some cases, the initial problem may not have been properly diagnosed or treated, or a new problem may arise.
Although second (revision) spine surgeries can be complicated, two Long Island-based spine specialists -- William J. Sonstein, MD, FACS, a neurosurgeon, and Richard S. Obedian, MD, FAAOS, an orthopaedic surgeon – have formed a unique collaboration to help increase the likelihood of success in revision surgeries, as well as in initial back operations.
Operating together for more than eight years, the surgeons’ collaboration is especially important in handling complex cases including revision surgeries, which can prove more difficult than initial surgeries.
“Our specialties and our surgical approaches complement one another, and the time we have spent performing surgeries together means that we can each anticipate what the other is going to do,” says Dr. Sonstein. “Because we operate together it often means that our patients spend less time under anesthesia, have less blood loss and have a lower likelihood of complications.”
Among the complex procedures the surgeons perform together is posterior lumbar interbody fusion (PLIF), a procedure that they have extensive experience with. The PLIF procedure involves making an incision in the patient’s back, removing problematic discs, and then grafting bone onto the surrounding vertebrae to provide spinal stability and prevent future disc slippage.
Another complex procedure done by Dr. Sonstein and Dr. Obedian is X-Stop®, which may be performed when the spinal canal narrows (stenosis). In this procedure, a small titanium implant is placed in the spine to create a permanent flexing that relieves pain. Kyphoplasty, another treatment performed by the surgeons, is a minimally invasive procedure used to repair compression fractures due to osteoporosis. Cement is injected into the fractured area, strengthening and stabilizing the fractured vertebrae.
“I recommend revision surgery very selectively,” says Dr. Sonstein. “Revision surgery today is more successful than it was even 10 years ago. Because it is usually more complicated and there are a number of factors outside of the surgeon’s skill that influence the surgery’s success, however, proper assessment of each case is essential.”
Dr. Sonstein cites a number of advances that have made revision surgeries more likely to succeed today than in the past. Among these are newer instrumentation; more advanced procedures; medical imaging techniques that can more accurately pinpoint problems; better surgeon training, and a better understanding of the spine’s mechanics.
Among the factors contributing to revision spine surgery success are the age and overall health of the patient, the reason for recurring pain, the type of initial procedure and the initial cause of back pain. Surgeon skill and experience are also very important.
Both Dr. Sonstein and Dr. Obedian conducted specialized spine fellowships following their medical residencies, including a significant amount of revision surgical experience. Dr. Sonstein currently performs a high volume of revision surgeries, another indicator of the likelihood of success.
Dr. Sonstein is a partner in Neurological Surgery, P.C., a private practice of leading neurosurgeons, and Chief of Neurosurgery at North Shore-LIJ Hospital at Plainview. Dr. Obedian is Chief of Spine Service at the hospital.