Pedicle screw instrumentation has become the foundation of thoracolumbar fixation techniques. For different reasons, pedicle screw revisions may need to occur. Some of the primary reasons for revision surgery are pseudarthrosis, adjacent segment disease, fractures, and infection. Some surgeons are more comfortable with revision work than others, and usually it is best accomplished at the hands of a skilled spine surgeon. Revision surgeries need to be entered into with a plan A, plan B, plan C, and plan D. Starting a revision surgery with only one plan and no backup options can lead to poor outcomes post-op. Revision surgeries involving pedicle screws can be tedious and difficult. Conversely, when well-planned and well-executed, revision surgery can go as smoothly as a virgin surgery. This chapter will discuss everything from preoperative imaging and identification of hardware to the intraoperative nuances of the surgeries.
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