Complex Revisions

Many spine surgeries today are straightforward and can be performed in a minimally invasive way on a outpatient basis. However, some surgical procedures (which doctors call “revisions”) are more complicated. Complex revisions should only be performed by experts in spinal surgery, like the physicians at the University Spine Center.
The most common types of complex revisions are to manage failed back surgery syndrome (FBSS), treat flatback syndrome, pseudoarthroses, and hardware failure.

Surgery for FBSS

Sometimes a person who undergoes back surgery does not get the desired results or the back surgery fails to correct the problem. When a patient continues to experience the same or worse pain following back surgery, some people incorrectly call this failed back surgery syndrome or FBSS. Medically speaking, it is not a true syndrome. It simply refers to a back surgery that did not produce the desired results.
In general there are a couple of reasons a surgery might not produce the expected results:

  • The first surgery failed to identify the exact cause of the pain and thus did not eliminate it.
  • The first surgery identified the problem correctly but was unable to fix it.

FBSS is actually a complicated condition. The University Spine Center is dedicated to answering your questions about FBSS and will help you determine the most appropriate course of corrective action.

Flatback Syndrome

When surgery is required to correct the alignment of the spine, this is sometimes called “flatback syndrome.” Flatback syndrome is another type of complex revision.
Flatback surgery is performed using an osteotomy or a cut into a bone. Typically, the vertebra are cut into more of a wedge shape, which allows the spine to better align.
Flatback surgery may require instrumentation or the use of rods, screws, plates, or other implanted devices to support the spine. Flatback surgery is considered a complex revision because it can be a complicated procedure. In some cases, people who have flatback syndrome have had a prior back surgery.


Sometimes called a “nonunion,” pseudoarthrosis occurs when a fracture does not heal properly so that it creates a false (pseudo) joint (arthrosis). Pseudoarthroses can occur anywhere in the body, but when they occur in the spine they are typically addressed with a surgical revision. A nonunion may require a bone graft or fixating hardware or both.

Hardware Failure

Sometimes prior back surgery involving a rod, pin, spacer, or other hardware requires a surgical revision when there is some problem with that hardware. If that implanted device does not function properly, a surgical revision may be required to remove and replace it.

What You Should Know About Complex Revisions

  • Every surgery carries with it potential benefits and potential risks. Even though negative effects are rare, you should still know about them.
  • Complex revisions are more challenging procedures than most other types of spine surgery.
  • If you have already had spinal surgery, the next surgeon who operates on your back will have to deal with scar tissue, the effects of the last surgery, and may have to remove some of the instrumentation used in earlier procedures.
  • When considering any type of complex revision, seek out experts in spinal surgery such as the physicians at University Spine Center.

Considering Complex Revision

Complex revision is a major procedure and should not be undertaken lightly. It should be considered by people:

  • Who did not get the desired results from a prior back surgery.
  • Who are under the care of spine experts who recommend the procedure.
  • Who are experiencing significant pain or other symptoms.
  • Who understand the potential risks and likelihood of success.

What to Expect from Complex Revision

Complex revision covers a range of procedures. A complex revision is generally a fairly complicated procedure that will require at least a short hospital stay and a recovery period of at least six to eight weeks. Your University Spine Center physicians will advise you how to prepare for the procedure and what to expect.