Nonsurgical treatment of lumbar disk herniation: are outcomes different in older adults?

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.