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

Authors

  • Pradeep Suri MD,

    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
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  • David J. Hunter MBBS, PhD,

    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
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  • Cristin Jouve MD,

    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
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  • Carol Hartigan MD,

    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
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  • Janet Limke MD,

    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
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  • Enrique Pena MD,

    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
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  • Ling Li MPH,

    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
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  • Jennifer Luz BA,

    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
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  • James Rainville MD

    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
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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

Abstract

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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