ABSTRACT
This chapter discusses the preoperative, operative, and postoperative management of patients undergoing revision lumbar decompression. The rate of revision lumbar decompression is increasing with the growth of the aging population. As more lumbar decompressions are performed, there inevitably will be a growing number of revision cases. After careful evaluation of the patient's history and physical examination findings and correlation with advanced imaging, a discussion should be held with the patient regarding the risks, benefits, and alternatives to nonoperative versus operative intervention. The risk/benefit ratio should be evaluated for potential associated complications, including seroma/wound complications with vancomycin use in low-risk-infection patients. There can be a myriad of complications following revision decompression, including those related to patient positioning, dural tear, nerve root injury, infection, thromboembolic events, epidural hematoma, and pars interarticular or facet fractures. If the patient is hemodynamically stable, antibiotics should be held prior to intraoperative culture obtainment.
