Nonsurgical Treatment of Lumbar Disk Herniation: Are Outcomes Different in Older Adults?

  1. Pradeep Suri MD,
  2. David J. Hunter MBBS, PhD,
  3. Cristin Jouve MD,
  4. Carol Hartigan MD,
  5. Janet Limke MD,
  6. Enrique Pena MD,
  7. Ling Li MPH,
  8. Jennifer Luz BA,
  9. James Rainville MD

Article first published online: 10 MAR 2011

DOI: 10.1111/j.1532-5415.2011.03316.x

Issue

Journal of the American Geriatrics Society

Journal of the American Geriatrics Society

Volume 59, Issue 3, pages 423–429, March 2011

Additional Information

How to Cite

Suri, P., Hunter, D. J., Jouve, C., Hartigan, C., Limke, J., Pena, E., Li, L., Luz, J. and Rainville, J. (2011), Nonsurgical Treatment of Lumbar Disk Herniation: Are Outcomes Different in Older Adults?. Journal of the American Geriatrics Society, 59: 423–429. doi: 10.1111/j.1532-5415.2011.03316.x

Author Information

  1. From the *Department of Physical Medicine and Rehabilitation, Harvard Medical School, Boston, Massachusetts; †New England Baptist Hospital, Boston, Massachusetts; ‡Spaulding Rehabilitation Hospital, Boston, Massachusetts; §Veterans Affairs Boston Healthcare System, Boston, Massachusetts; ∥Northern Clinical School, University of Sydney, Sydney, New South Wales, Australia; and #Tufts University School of Medicine, Boston, Massachusetts

*Address correspondence to Pradeep Suri, Division of Research, New England Baptist Hospital, 125 Parker Hill Ave, Boston, MA 02130. E-mail: psuri@caregroup.harvard.edu

Publication History

  1. Issue published online: 10 MAR 2011
  2. Article first published online: 10 MAR 2011

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Keywords:

  • herniation;
  • intervertebral disk displacement;
  • geriatrics;
  • outcomes

OBJECTIVES: To determine whether older adults (aged ≥60) experience less improvement in disability and pain with nonsurgical treatment of lumbar disk herniation (LDH) than younger adults (<60).

DESIGN: Prospective longitudinal comparative cohort study.

SETTING: Outpatient specialty spine clinic.

PARTICIPANTS: One hundred thirty-three consecutive patients with radicular pain and magnetic resonance–confirmed acute LDH (89 younger, 44 older).

INTERVENTION: Nonsurgical treatment customized for the individual patient.

MEASUREMENTS: Patient-reported disability on the Oswestry Disability Index (ODI), leg pain intensity, and back pain intensity were recorded at baseline and 1, 3, and 6 months. The primary outcome was the ODI change score at 6 months. Secondary longitudinal analyses examined rates of change over the follow-up period.

RESULTS: Older adults demonstrated improvements in ODI (range 0–100) and pain intensity (range 0–10) with nonsurgical treatment that were not significantly different from those seen in younger adults at 6 month follow-up, with or without adjustment for potential confounders. Adjusted mean improvement in older and younger adults were 31 versus 33 (P=.63) for ODI, 4.5 versus 4.5 (P=.99) for leg pain, and 2.4 versus 2.7 for back pain (P=.69). A greater amount of the total improvement in leg pain and back pain in older adults was noted in the first month of follow-up than in younger adults.

CONCLUSION: These preliminary findings suggest that the outcomes of LDH with nonsurgical treatment were not worse in older adults (≥60) than in younger adults (<60). Future research is warranted to examine nonsurgical treatment for LDH in older adults.

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