Influence of Laminectomy With Concomitant Discectomy on the Postoperative Progression of Lumbar Spine Degeneration

Study Design: A single-center retrospective study. Objective: This study aimed to evaluate the postoperative progression of degenerative lumbar spinal disease (DLSD) following lumbar laminectomy with or without concomitant discectomy for lumbar canal stenosis (LCS). Summary of Background Data: The impact of laminectomy combined with concomitant discectomy on LCS outcomes has not been conclusively elucidated. Materials and Methods: This study included 242 patients (138 men, 104 women; mean age: 73.1 yr) with a follow-up period of 2.0 years. Patients underwent either bilateral partial laminectomy (BPL, n=140) or lumbar spinous process-splitting laminectomy (LSPSL, n=102), with or without concomitant discectomy. Results: Thirty-nine patients underwent laminectomy with concomitant discectomy, whereas 203 underwent laminectomy alone. Progression of DLSD (including disc herniation, canal stenosis, foraminal stenosis, or facet joint cysts) was observed in 28.2% (11/39) of the laminectomy with concomitant discectomy (LC) group compared with 17.7% (36/203) in the laminectomy-alone group patients. LC was associated with a significantly higher incidence of lumbar disc herniation (LDH), which developed in 22.6% (7/31) of patients undergoing BPL with concomitant discectomy, with reoperations in 9.7% (3/31). Among the eight patients undergoing LSPSL with concomitant discectomy, LDH developed in 12.5% (1/8), with reoperation in 0% (0/8). Conclusions: LC was associated with an increased incidence of LDH. Avoiding concomitant discectomy, when adequate posterior decompression is achievable, may reduce the risk of LDH. Level of Evidence: Level III.