Surgical treatment of lumbar disc herniation in different ages-evaluation of 11,237 patients.
BACKGROUND CONTEXT
Surgical treatment of lumbar disc herniation (LDH) may lead to different outcomes in young, middle-aged, and elderly patients. However, no study has, by the same data ascertainment, evaluated referral pattern, improvement, and outcome in different age strata.


PURPOSE
This study aimed to evaluate referral pattern and outcome in patients of different ages surgically treated because of LDH.


STUDY DESIGN
This is a register study of prospectively collected data.


PATIENT SAMPLE
In SweSpine, the national Swedish register for spinal surgery, we identified 11,237 patients who between 2000 and 2010 had their outcome of LDH surgery registered in pre-, per-, and 1-year postoperative evaluations.


OUTCOME MEASURES
The data collected included age, gender, smoking habits, walking distance, preoperative duration and degree of back and leg pain, consumption of analgesics, quality of life in the patient-reported outcome measure (PROM) Short-Form 36 (SF-36) and EuroQol 5 dimensions (EQ5D), disability in the Oswestry Disability Index, operated level, type of surgery, and complications.


METHODS
We compared the outcome in patients within different 10-year age strata. IBM SPSS Statistics 22 was used in the statistical calculations. No funding was obtained for this study. The authors have no conflicts of interest to declare.


RESULTS
Patients in all ages referred to surgery had inferior PROM data compared with published normative age-matched PROM data. Referral to LDH surgery demanded of each 10-year strata statistically significantly more pain, lower quality of life, and more disability (all p<.001). Surgery markedly improved quality of life and reduced disability in all age groups (all p<.001), but with statistically significantly less PROM improvement with each older 10-year strata (all p<.001). This resulted in statistically significantly inferior PROM values for pain, quality of life, and disability postoperatively for each 10-year strata (all p<.001). There were also more complications (p<.001) with each 10-year older strata.


CONCLUSIONS
In general, older patients referred to LDH surgery have statistically significantly inferior PROM scores, improve less, and reach inferior PROM scores postoperatively. The clinical relevance must however be questioned because most patients reach, independent of age group, the defined level for a successful outcome, and the patient satisfaction rate is high.
['Strömqvist|Fredrik|F|', 'Strömqvist|Björn|B|', 'Jönsson|Bo|B|', 'Karlsson|Magnus K|MK|']
D000328:Adult D000367:Age Factors D000368:Aged D005260:Female D006801:Humans D055959:Intervertebral Disc Degeneration D007405:Intervertebral Disc Displacement D008159:Lumbar Vertebrae D008297:Male D008875:Middle Aged D000071066:Patient Reported Outcome Measures D011183:Postoperative Complications D011788:Quality of Life D013548:Sweden
Lumbar disc herniation Outcome Gender PROMs Females Males