Department of Physical Medicine and Rehabilitation, Harvard Medical School, Boston, Massachusetts, USA.
J Am Geriatr Soc. 2011 Mar;59(3):423-9. doi: 10.1111/j.1532-5415.2011.03316.x.
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).
Prospective longitudinal comparative cohort study.
Outpatient specialty spine clinic.
One hundred thirty-three consecutive patients with radicular pain and magnetic resonance-confirmed acute LDH (89 younger, 44 older).
Nonsurgical treatment customized for the individual patient.
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.
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.
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.
确定与年轻成年人（<60 岁）相比，老年成年人（≥60 岁）在非手术治疗腰椎间盘突出症（LDH）时，在残疾和疼痛方面的改善是否更少。
前瞻性纵向比较队列研究。
门诊专科脊柱诊所。
133 例连续的根性疼痛和磁共振证实的急性 LDH 患者（89 例年轻，44 例年老）。
为每位患者定制的非手术治疗。
患者报告的 Oswestry 残疾指数（ODI）、腿部疼痛强度和背部疼痛强度，在基线和 1、3 和 6 个月时进行记录。主要结局是 6 个月时的 ODI 变化评分。次要纵向分析检查了随访期间的变化率。
老年成年人在接受非手术治疗后，ODI（0-100 范围）和疼痛强度（0-10 范围）均有改善，与年轻成年人在 6 个月随访时的改善相比，没有显著差异，无论是否调整潜在混杂因素。调整后的老年和年轻成年人的平均改善程度分别为 ODI 31 分与 33 分（P =.63）、腿部疼痛 4.5 分与 4.5 分（P =.99）、背部疼痛 2.4 分与 2.7 分（P =.69）。老年成年人在随访的第一个月内腿部疼痛和背部疼痛的总改善量大于年轻成年人。
这些初步发现表明，与年轻成年人（<60 岁）相比，老年成年人（≥60 岁）在非手术治疗 LDH 方面的结果并不更差。需要进一步研究非手术治疗老年成年人 LDH 的方法。
