Disc bulging predicts poor outcomes of decompression surgery for lumbar spinal canal stenosis

Lumbar spinal canal stenosis (LSCS) is a prevalent degenerative musculoskeletal disorder in aging populations. While decompression surgery is a standard treatment, some patients require revision surgery. Disc bulging, a distinct component of the degenerative process separate from disc herniation, contributes to spinal stenosis. However, its impact on surgical outcomes for LSCS has never been examined. This study aimed to elucidate the influence of disc bulging on outcomes of decompressive surgery for LSCS, addressing a critical knowledge gap.

This retrospective study analyzed the clinical data of 517 consecutive patients involving 912 intervertebral levels who underwent decompression surgery for LSCS. We statistically evaluated the association between disc bulging and revision surgery. Two measures were utilized to assess disc bulging: the extended area of the disc (EAD), referring to the horizontal expansion of the disc, and the disc bulging length (DBL), which indicated the degree of disc intrusion into the spinal canal. Other conventional radiographical assessments and patient background characteristics were also evaluated.

Revision surgery was required in 28 patients (5.4%) involving 31 intervertebral levels (3.4%). Patients requiring revision surgery were significantly younger and more likely to smoke. Both the EAD and DBL were significantly higher in the revision group compared to the no-revision group (P <.001 for both). We did not observe an association between other conventional radiographical assessments and revision surgery. Multivariable analysis revealed that the EAD and DBL were independently correlated with revision surgery.

This study demonstrated that disc bulging, particularly as measured by EAD, is a significant predictor of revision surgery following decompression for LSCS. These findings highlight the importance of pre-operative assessment of disc bulging in predicting surgical outcomes and optimizing patient selection for decompressive procedures.