Significant back and leg symptoms develop in approximately 10%-15% of patients who have undergone a spinal decompression procedure and approximately 15%-20% of patients who have had a spinal fusion procedure for degenerative disease of the lumbar spine during the ensuing 3-5 year so that they require revision lumbar surgery. The cause for their symptoms has to be diligently looked for, as that is a main predictor of good outcome following revision surgery. Good history taking, including a detailed old chart review, repeat physical evaluation, and input from therapists--physical and psychological, neurologist, and other caregivers--should be sought. These, together with intelligent use of investigations, go a long way in helping establish a cause for failure. Furthermore, developing a revision surgical strategy is also an intellectual exercise in which a simple algorithmic approach may not always work. The process of evaluation and surgical management for failed lumbar degeneration is a science and an art that requires a great deal of understanding and commitment on the part of the surgeon. The temporal trend of improving outcomes is aided in part by emerging technologies, however, one has to be constantly aware of simple factors that influence outcome. The use of published literature and experiences of peers helps one offer appropriate surgical intervention while improving the long-term results of revision surgery of the lumbar spine.
