Gender differences in the surgical treatment of lumbar disc herniation in elderly.
Outcome after lumbar disc herniation (LDH) surgery in middle-aged patient is usually reported to fulfill the criteria for successful outcome. It is also known that women in these years have an inferior outcome compared to men. This study evaluates whether the same gender differences exist in elderly.



In the national Swedish register for spine surgery (SweSpine) we identified 1668 patients ≥65 years. 1250 of these patients had both pre- and 1-year postoperative data registered, 53 % males with mean age 70.6 ± 5.0 (mean ± SD) and 47 % females with mean age 71.3 ± 5.2. All were surgically treated due to LDH between 2000 and 2012.



Before surgery both men and women had severe impairment, compared to normative data, in all patient-reported outcome measures (PROMs), with women having inferior status to men. Improvement by surgery was similar in both genders but neither of them reached normative values in quality of life as compared to normative age-matched individuals. As a consequence of this women 1 year after surgery had more back and leg pain, higher consumption of analgesics, greater impairment in walking distance and inferior scoring in virtually all registered PROMs compared to men (all p < 0.005). In spite of this women were as satisfied with the surgical outcome as the men.



Elderly women with LDH surgery report inferior outcome compared to males, mainly as a result of being referred to surgery with an inferior status but are despite this as satisfied with outcome as the men.
Departments of Clinical Sciences and Orthopaedics, Clinical and Molecular Osteoporosis Research Unit, Skane University Hospital, Lund University, Malmö, Sweden. fredrik.stromqvist@med.lu.se.|Department of Orthopaedics, Skane University Hospital, 205 02, Malmo, Sweden. fredrik.stromqvist@med.lu.se.
Fredrik
F
Strömqvist
Departments of Clinical Sciences and Orthopaedics, Clinical and Molecular Osteoporosis Research Unit, Skane University Hospital, Lund University, Malmö, Sweden.
Björn
B
Strömqvist
Departments of Clinical Sciences and Orthopaedics, Clinical and Molecular Osteoporosis Research Unit, Skane University Hospital, Lund University, Malmö, Sweden.
Bo
B
Jönsson
Departments of Clinical Sciences and Orthopaedics, Clinical and Molecular Osteoporosis Research Unit, Skane University Hospital, Lund University, Malmö, Sweden.
Magnus K
MK
Karlsson
D000368:Aged; D000700:Analgesics / Q000627:therapeutic use; D004185:Disability Evaluation; D005260:Female; D006801:Humans; D007405:Intervertebral Disc Displacement / Q000601:surgery*; D008159:Lumbar Vertebrae / Q000601:surgery*; D008297:Male; D010147:Pain Measurement; D000071066:Patient Reported Outcome Measures; D017060:Patient Satisfaction; D011788:Quality of Life; D012042:Registries; D012737:Sex Factors; D013548:Sweden
D000700:Analgesics
Elderly; Gender; Lumbar disc herniation; Outcome; PROMS