ABSTRACT
Preoperative imaging should begin with anterioposterior, lateral, and flexion/extension views. Patients with back pain and/or radiculopathy secondary to stenosis and disk degeneration adjacent to a prior fusion can be treated with anterior, posterior, lateral, or combined approaches. For the posterior approach, preoperative imaging studies should be reviewed carefully to determine stenotic areas and their relationship to the prior surgical site. The operative technique should be chosen based on the patient's pathology and chief complaint. Patients with an adjacent segment disk herniation and no instability may benefit from microdiskectomy. Postoperative management begins in the operating room. Some surgeons routinely use postoperative bracing. There is no strong evidence for or against the use of braces. Once the patient is extubated, he or she should be mobilized with physical therapy. The incidence of complications is significantly increased in the revision setting. Surgical complications range from incidental durotomy to large-volume blood loss.
