title: Failed less invasive lumbar spine surgery as a predictor of subsequent fusion outcomes.
abstract: OBJECTIVE
  It is not uncommon for patients to undergo less invasive spine surgery (LISS) prior to succumbing to lumbar fusion; however, the effect of failed LISS on subsequent fusion outcomes is relatively unknown. The aim of this study was to test the hypothesis that patients who suffered failed LISS would afford inferior subsequent fusion outcomes when compared to patients who did not have prior LISS.
  
  
  METHODS
  After IRB approval, registry from a spine surgeon was queried for consecutive patients who underwent fusion for intractable low back pain. The 47 qualifying patients were enrolled and split into two groups based upon a history for prior LISS: a prior surgery group (PSG) and a non-prior surgery group (nPSG).
  
  
  RESULTS
  Typical postoperative outcome questionnaires, which were available in 80.9% of the patients (38/47) at an average time point of 40.4 months (range, 13.5-66.1 months), were comparatively analysed and failed to demonstrate significant difference between the groups, e.g. PSG v. nPSG: ODI--14.6 ± 10.9 vs. 17.2 ± 19.4 (P = 0.60); SF12-PCS--10.9 ± 11.0 vs. 8.7 ± 12.4 (p = 0.59); bNRS--3.0 (range -2-7) vs. 2.0 (range -3-8) (p = 0.91). Patient satisfaction, return to work rates, peri-operative complications, success of fusion and rate of revision surgery were also not different.
  
  
  CONCLUSIONS
  Although limited by size and retrospective design, the results of this rare investigation suggest that patients who experience a failed LISS prior to undergoing fusion will not suffer inferior fusion outcomes when compared to patients who did not undergo prior LISS.
authors.affiliation: Spine Research, The Steadman Philippon Research Institute, Vail, USA, dgillard@sprivail.org.
authors.forename: Douglas M
authors.initials: DM
authors.lastname: Gillard
authors.forename: Donald S
authors.initials: DS
authors.lastname: Corenman
authors.forename: Grant J
authors.initials: GJ
authors.lastname: Dornan
mesh_terms: D000328:Adult; D002908:Chronic Disease; D017586:Diskectomy; D005260:Female; D006801:Humans; D007796:Laminectomy; D017116:Low Back Pain / Q000601:surgery*; D008297:Male; D019060:Minimally Invasive Surgical Procedures; D017060:Patient Satisfaction; D012086:Reoperation; D062707:Return to Work; D013123:Spinal Fusion / Q000379:methods*; D013817:Thermography; D017211:Treatment Failure