The Multiply Operated Lumbar Spine: Clinical Update 2008

This article focuses on the spectrum of issues and problems associated with the multiply operated lumbar spine. The review covers emergency indications for lumbar spine surgery in the multiply operated spine as well as surgical principles for a recurrent lumbar disc herniation or recurrent lumbar spinal stenosis. The review also approaches issues in the multiply operated lumbar spine with new technology as well as more traditional challenges like instability and nonunion, as well as psychosocial issues that exist in this difficult group of patients. The article ends with a discussion on safety issues and expectations of patients as well as other factors, such as the increasing prevalence of osteoporosis as our revision lumbar spine patient population over the age of 60 steadily increases.

Keywords: recurrent lumbar disc herniation, recurrent lumbar spinal stenosis, multiply operated spine, iatrogenic instability, acute cauda equina syndrome