Surgical treatment of lumbar disc herniation in different ages-evaluation of 11,237 patients.
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.



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



This is a register study of prospectively collected data.



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.



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.



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.



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.



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.
Clinical and Molecular Osteoporosis Research Unit, Department of Clinical Sciences, Lund University, Skåne University Hospital, Malmö SE-205 02, Sweden; Clinical and Molecular Osteoporosis Research Unit, Department of Orthopaedics, Lund University, Skåne University Hospital, Malmö SE-205 02, Sweden. Electronic address: fredrik.stromqvist@med.lu.se.
Fredrik
F
Strömqvist
Clinical and Molecular Osteoporosis Research Unit, Department of Clinical Sciences, Lund University, Skåne University Hospital, Malmö SE-205 02, Sweden; Clinical and Molecular Osteoporosis Research Unit, Department of Orthopaedics, Lund University, Skåne University Hospital, Malmö SE-205 02, Sweden.
Björn
B
Strömqvist
Clinical and Molecular Osteoporosis Research Unit, Department of Clinical Sciences, Lund University, Skåne University Hospital, Malmö SE-205 02, Sweden; Clinical and Molecular Osteoporosis Research Unit, Department of Orthopaedics, Lund University, Skåne University Hospital, Malmö SE-205 02, Sweden.
Bo
B
Jönsson
Clinical and Molecular Osteoporosis Research Unit, Department of Clinical Sciences, Lund University, Skåne University Hospital, Malmö SE-205 02, Sweden; Clinical and Molecular Osteoporosis Research Unit, Department of Orthopaedics, Lund University, Skåne University Hospital, Malmö SE-205 02, Sweden.
Magnus K
MK
Karlsson
D000328:Adult; D000367:Age Factors; D000368:Aged; D005260:Female; D006801:Humans; D055959:Intervertebral Disc Degeneration / Q000601:surgery*; D007405:Intervertebral Disc Displacement / Q000601:surgery*; D008159:Lumbar Vertebrae / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D000071066:Patient Reported Outcome Measures; D011183:Postoperative Complications / Q000453:epidemiology*; D011788:Quality of Life; D013548:Sweden
Females; Gender; Lumbar disc herniation; Males; Outcome; PROMs