{"title":"Disc bulging predicts poor outcomes of decompression surgery for lumbar spinal canal stenosis.","authors":"Kyohei Kin, Akira Kusumegi, Masashi Chinen, Shohei Okamoto, Toshiharu Mitsuhashi, Yuichi Takahashi, Kenki Nishida","doi":"10.1007/s00586-025-09066-7","DOIUrl":null,"url":null,"abstract":"<p><strong>Purpose: </strong>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.</p><p><strong>Methods: </strong>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.</p><p><strong>Results: </strong>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.</p><p><strong>Conclusion: </strong>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.</p>","PeriodicalId":12323,"journal":{"name":"European Spine Journal","volume":" ","pages":""},"PeriodicalIF":2.6000,"publicationDate":"2025-06-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"European Spine Journal","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1007/s00586-025-09066-7","RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q2","JCRName":"CLINICAL NEUROLOGY","Score":null,"Total":0}
引用次数: 0
Abstract
Purpose: 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.
Methods: 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.
Results: 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.
Conclusion: 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.
期刊介绍：
"European Spine Journal" is a publication founded in response to the increasing trend toward specialization in spinal surgery and spinal pathology in general. The Journal is devoted to all spine related disciplines, including functional and surgical anatomy of the spine, biomechanics and pathophysiology, diagnostic procedures, and neurology, surgery and outcomes. The aim of "European Spine Journal" is to support the further development of highly innovative spine treatments including but not restricted to surgery and to provide an integrated and balanced view of diagnostic, research and treatment procedures as well as outcomes that will enhance effective collaboration among specialists worldwide. The “European Spine Journal” also participates in education by means of videos, interactive meetings and the endorsement of educative efforts.
Official publication of EUROSPINE, The Spine Society of Europe
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