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.
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.
Spine J. 2017 Nov;17(11):1577-1585. doi: 10.1016/j.spinee.2017.03.013. Epub 2017 Mar 20.
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.
腰椎间盘突出症（LDH）的手术治疗在年轻、中年和老年患者中可能会产生不同的结果。然而，尚无研究通过相同的数据确定来评估不同年龄组的转诊模式、改善和结果。
本研究旨在评估因 LDH 而接受手术治疗的不同年龄段患者的转诊模式和结果。
这是一项前瞻性收集数据的登记研究。
在 SweSpine（瑞典全国脊柱手术登记处）中，我们确定了 11237 名患者，他们在 2000 年至 2010 年间的 LDH 手术结果在术前、围手术期和术后 1 年进行了评估。
收集的数据包括年龄、性别、吸烟习惯、行走距离、术前腰背疼痛的持续时间和程度、镇痛药的使用、患者报告的结果测量（PROM）短表 36（SF-36）和欧洲五维健康量表（EQ5D）的生活质量、Oswestry 残疾指数的残疾程度、手术水平、手术类型和并发症。
我们比较了不同 10 年年龄组患者的结果。IBM SPSS Statistics 22 用于统计计算。本研究未获得任何资金。作者没有利益冲突需要声明。
所有年龄段的患者在接受手术治疗时的 PROM 数据均低于已发表的与年龄匹配的 PROM 数据。每 10 年的患者转诊到手术治疗需要更多的疼痛、更低的生活质量和更高的残疾（均 p<.001）。所有年龄组的手术均显著改善了生活质量并降低了残疾程度（均 p<.001），但每个年龄较大的 10 年组的 PROM 改善程度都有统计学显著降低（均 p<.001）。这导致每个 10 年年龄组术后的 PROM 值在疼痛、生活质量和残疾方面均明显下降（均 p<.001）。每个 10 年年龄组的并发症也更多（p<.001）。
总体而言，年龄较大的患者转诊到 LDH 手术治疗的 PROM 评分明显较低，改善程度较小，术后 PROM 评分较低。然而，由于大多数患者无论年龄组如何都达到了成功结果的定义水平，并且患者满意度很高，因此必须质疑其临床相关性。
