Traditional outcome after spine reconstruction surgery may be measured based on symptomatic relief and the presence of a solid bony fusion. Contrary to intuitive thinking though, the presence of a solid fusion does not necessarily correlate completely with the resolution of symptoms. Such factors as the correct primary diagnosis as well as technical considerations about the surgery may improve the overall results over the short term.

Distraction instrumentation placed by another surgeon for lumbar fusion has produced imbalance, forward tilting of the spine and "flatback" syndrome. Continued, severe low back pain necessitated revision reconstruction spine surgery.

Balance is absolutely critical in spine surgery. The delineation between good and excellent surgery may depend on how well the surgeon balances the spine during the reconstruction.

A spine which is decompensated or tilted forward, will require increased energy utilization by the various muscles which support the head, the neck, and the rest of the spine. A spine which is out of alignment and pitched forward will require various back, buttock, and leg muscles to "right the spine" during activities such as sitting and walking. This increased energy requirement may cause the muscles to become easily fatigued which may in fact cause pain. Reconstruction surgery which reduces the normal curvature of the spine of the lumbar spine (flatback syndrome) may in fact leave a patient more vulnerable for symptoms than prior to reconstruction.

When choosing a surgeon for any sort of spinal reconstruction, it is absolutely critical that the question of balance be raised. Although various techniques may seem "state-of-the-art" or "minimally invasive" any technique which does not attempt to recreate normal spinal balance may have long lasting negative or adverse results on the patient's spine "health."

Last updated: 9/20/02