Printable checklist: records to send before your visit

Send the actual images (disc, cloud link or image-sharing portal), not just the written reports. I need to measure the images myself.

Surgery records

Operative report(s) for every spine surgery
Hospital discharge summary
Implant record or sticker sheet (manufacturer and type of screws and rods)
Office notes from your previous surgeon, especially the most recent

Imaging (images plus reports)

X-rays from before your first surgery, if you can get them
X-rays from soon after surgery
Your most recent standing X-rays, ideally full-length
CT scan of the fused area, if you’ve had one
MRI or CT myelogram, if you’ve had one

Health records

Bone density (DEXA) report, ideally from the last 6 months
Current medication list, including bone medications and blood thinners
Recent lab results, if available
Physical therapy and injection notes

To send records or ask for a review, contact my office at (401) 443-4270 or email me at bdiebo@uoi.com.

Why does the first visit focus on the past?

A second operation works best when it addresses what happened the first time. Common contributors include:

the bones not fusing
weak bone
smoking
a construct that wasn’t strong enough
alignment that was never fully corrected

Often more than one is involved.

What problems lead to revision surgery?

In long-term studies of adult deformity surgery, about 9% to 17% of patients needed a revision, depending on follow-up and complexity. The most common reasons:

the fusion didn’t heal (pseudarthrosis), often found when a rod breaks
problems above the fusion: the spine bends forward or a vertebra fails at the top (proximal junctional kyphosis or failure)
problems below the fusion, or wear at the next level
loss of correction or alignment, including flatback
loose or broken screws, or infection

In one large series, almost half of revisions happened within two years, and about 1 in 7 came more than 10 years later.

Does a broken rod always need surgery?

No. If you have little pain and your alignment is good, watching it is often recommended. Surgery is usually considered when pain, imbalance, nerve symptoms or loss of function are the problem.

What will I want to know?

Your first operation

When, who, and why?
How many levels? Did it go down to the pelvis?
Did you improve afterward? For how long?

What changed

When did the new pain or leaning start?
Sudden (a “pop,” a fall) or gradual?
Back, legs, or both? Worse standing, sitting or walking?
New weakness, numbness or balance problems?

Your health now

Do you smoke or use nicotine?
Bone density scan? Bone medication?
Heart, lung, kidney or diabetes problems?

What tests might be ordered?

full-length standing X-rays, front and side, including the hips
CT scan, the most accurate test of whether a fusion healed
CT myelogram, since metal can blur an MRI
bone density scan and nutrition blood tests
medical or heart clearance

Can you get stronger before revision surgery?

Often, yes. If your bones are weak, a bone-building medication is often started before an elective revision. Quitting nicotine and improving nutrition also lower the risk of the problem coming back.

Do people improve after revision surgery?

Most do. In a multicenter study, patients who needed a revision still improved by two years, somewhat less than those who didn’t, with similar satisfaction. Recovery after revisions for broken rods or junctional failure tends to be slower at first and usually levels out by five years.

When should you be seen urgently?

Seek care right away for new leg weakness, loss of bladder or bowel control, fever with wound drainage, or a sudden severe increase in pain after a fall.

Told you need surgery but haven’t had it yet? Getting a second opinion →

Sources

Sherif S, Arlet V. Revision surgery for non-union in adult spinal deformity. Eur Spine J, 2020.
Martini C, et al. Revision strategies for failed adult spinal deformity surgery. Eur Spine J, 2020.
Pichelmann MA, et al. Revision rates following primary adult spinal deformity surgery. Spine, 2010. PMID 20038867.
Passias PG, et al. Predictors of revision surgical procedure in adult spinal deformity. JBJS Am, 2016. PMID 27053581.
Passias PG, et al. Cause and effect of revisions in adult spinal deformity surgery. Spine J, 2025. PMID 39706345.
Peters MJM, et al. Diagnostic accuracy of imaging modalities to detect pseudarthrosis. Skeletal Radiol, 2019. PMID 30796507.
Nguyen NL, et al. Proximal junctional kyphosis and failure. Curr Rev Musculoskelet Med, 2016.
Diebo BG, et al. Defining modern iatrogenic flatback syndrome. Eur Spine J, 2024.