Evaluation and Treatment of Sagittal Plane Instability and Deformity in the Previously Operated Lumbar Spine

The effective treatment of lumbar spinal sagittal deformity in the previously operated spine, which requires careful preoperative evaluation, thoughtful surgical planning, and meticulous operative technique is described. The configuration of the deformity and its flexibility can be determined with clinical and radiographic evaluations. This helps the surgeon to decide on the necessity, type, and location of any osteotomies. Instrumentation constructs are designed to maintain spinal alignment, to maximize the likelihood of achieving solid arthrodesis, and to minimize the probability of developing a junctional syndrome. With careful planning and execution, revision surgery for lumbar sagittal deformity can be performed safely and effectively and have a beneficial impact on a patient's quality of life.