ABSTRACT
This chapter discusses failure of posterolateral fusion solely at the index level. Decisions must be made as to the safety with which the surgeon can proceed with the procedure. With the need of instrumentation, active infection is an absolute contraindication to surgery. Revision surgery should be completed by a spine specialist with experience in revisions, as they are more complex and involve added risks. The screws are removed so that the facetectomy can be performed with either small osteotomes or a high-speed drill to deliver appropriate decompression of neural elements and to allow access to the disc. Preoperative planning is essential to revise a failed posterolateral fusion. Postoperatively, the patient should be monitored in a postanesthesia care unit. Pain should be adequately controlled, and if needed, acute pain management consultation should be obtained. The patient should be monitored for hemodynamic instability and a complete blood count, bone morphogenetic protein, and coags should be drawn and corrected as needed.
