title: Effect of previous surgery on clinical outcome following 1-level lumbar arthroplasty.
abstract: OBJECTIVE
  A secondary lumbar surgery at a previously surgically treated level is believed to result in minimal clinical improvement. The clinical results of the CHARITE Investigational Device Exemption (IDE) study were analyzed to assess the effect of previous surgery on clinical outcomes following either total disc replacement with the CHARITE device or anterior lumbar interbody fusion with a BAK cage and iliac crest autograft.
  
  
  METHODS
  Patients with prior microdiscectomy, laminectomy, or minimal medial facetectomy were not excluded from enrollment in the CHARITE IDE study. Thus, the following 3 groups were analyzed: all patients treated with the CHARITE Artificial Disc, whether randomized or nonrandomized; only patients treated with CHARITE devices randomized against patients with BAK devices; and control patients with BAK devices. Each group was further subdivided based on the patients' medical history, whether they had undergone prior surgery (prior surgery group) or had not (no prior surgery group). For all groups, baseline demographics were collected and compared for any potential recruitment bias. Postoperative improvements based on Oswestry Disability Index (ODI), visual analog scale (VAS), and patient satisfaction scores were further collected and statistically analyzed.
  
  
  RESULTS
  For all 3 groups, there were no statistical differences in clinical improvement from 3 months to 2 years postoperatively as measured using ODI and VAS scores between the subgroups (those who had prior surgery and those who did not).
  
  
  CONCLUSIONS
  Patients indicated for 1-level lumbar arthroplasty with previous lumbar decompressive surgery can be expected to have similar clinical outcomes to patients undergoing arthroplasty without prior lumbar decompressive surgery. Similarly, candidates for anterior lumbar fusion with prior decompressive surgery may experience similar benefits from the surgical procedure as those without.
authors.affiliation: Illinois Neuro-Spine Center, Aurora, Illinois 60504, USA. fgeisler@fredgeisler.com
authors.forename: Fred H
authors.initials: FH
authors.lastname: Geisler
authors.forename: Richard D
authors.initials: RD
authors.lastname: Guyer
authors.forename: Scott L
authors.initials: SL
authors.lastname: Blumenthal
authors.forename: Paul C
authors.initials: PC
authors.lastname: McAfee
authors.forename: Andrew
authors.initials: A
authors.lastname: Cappuccino
authors.forename: Fabien
authors.initials: F
authors.lastname: Bitan
authors.forename: John J
authors.initials: JJ
authors.lastname: Regan
mesh_terms: D000293:Adolescent; D000328:Adult; D019643:Arthroplasty, Replacement / Q000009:adverse effects / Q000295:instrumentation; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007595:Joint Prosthesis; D008159:Lumbar Vertebrae; D008297:Male; D008875:Middle Aged; D010147:Pain Measurement; D017060:Patient Satisfaction; D012086:Reoperation; D013122:Spinal Diseases / Q000601:surgery*; D013997:Time Factors; D016896:Treatment Outcome