The outcome of lumbar disc herniation surgery is worse in old adults than in young adults

Figures & data

Table 1. Dropout analysis comparing elderly and younger patients with complete and missing postoperative data in SweSpine regarding age, gender, level operated, VAS as an estimation of back and leg pain, SF-36 as an estimation of quality of life, and ODI as an estimation of disability. Elderly is defined as those aged ≥65 years, and younger refers to the sex-matched comparison group aged 20–64

	Elderly			Younger
	Included	Lost to 1 year	p-value	Included	Lost to 1 year	p-value
	n = 1,250	n = 418		n = 12,840	n = 5,273
Age, mean (SD)	71 (5.2)	73 (6.7)	< 0.001	43 (10)	41 (10)	< 0.001
Men/women, %	53/47	42/58	< 0.001	55/45	60/40	< 0.001
Operated level
L4–L5, %	53	53	0.2	41	41	0.2
L5–S1, %	20	22		53	53
VAS back pain^a	53 (51–55)	55 (52–59)	0.2	46 (46–47)	48 (47–49)	0.02
VAS leg pain^a	69 (67–70)	65 (62–68)	0.03	66 (66–67)	66 (65–66)	0.4
SF-36 PCS^a	37 (36–38)	35 (33–36)	0.008	37 (36–37)	35 (35–36)	< 0.001
SF-36 MCS^a	28 (28–29)	28 (27–29)	0.4	31 (31–32)	31 (30–31)	< 0.001
ODI-index^a	50 (49–51)	51 (49–53)	0.5	48 (48–49)	49 (48–49)	0.2

a mean (95% CI)

Figure 1. Quality of life estimated by SF-36, pre- and postoperatively, in elderly and younger patients operated for LDH compared to a published age-matched reference data population* (Sullivan et al. 1994). Elderly is defi ned as those aged ≥65 years, and younger refers to the sex-matched comparison group aged 20–64. For Abbreviations, see Table 3.

Table 2. Preoperative and 1-year postoperative data regarding age, smoking, duration of back and leg pain, consumption of analgesics, and estimated walking distances. Elderly is defined as those aged ≥65 years, and younger refers to the sex-matched comparison group aged 20–64

	Preoperatively			Postoperatively
	Elderly	Younger	p-value	Elderly	Younger	p-value
Age, mean (SD)	71 (5)	43 (10)
Sex (M/F), %	53/47	55/45	0.2
Smoking, %	11	21	< 0.001	NA	NA	NA
Months of back pain, %			0.1	NA	NA	NA
Had no back pain	6	6
> 3–12	43	46
> 12–24	16	16
> 24	22	19
Months of leg pain, %			0.004	NA	NA	NA
Had no leg pain	1	1
≤ 3	16	18
> 3–12	49	53
> 12–24	18	15
> 24	16	13
Analgesics, %			0.4			< 0.001
None	11	12		45	51
Intermittent	28	29		33	32
Regular	62	60		22	17
Walking distance, %			< 0.001			< 0.001
≤ 100 m	48	32		13	4
> 100–500 m	25	21		18	8
> 500–1,000 m	12	16		16	11
> 1,000 m	15	31		53	77

NA: not applicable.

Table 3. Preoperative and 1-year postoperative data regarding VAS as an estimation of back and leg pain, EuroQol and SF-36 as estimations of quality of life, and ODI as an estimation of disability. Data are mean (95% CI). Elderly is defined as those aged ≥65 years, and younger refers to the sex-matched comparison group aged 20–64

	Preoperatively			Postoperatively
	Elderly	Younger	p-value	Elderly	Younger	p-value
VAS back pain	53 (51–55)	46 (45–47)	< 0.001	27 (26–29)	25 (25–26)	0.03
VAS leg pain	69 (67–70)	66 (66–67)	0.003	30 (28–32)	22 (21–22)	< 0.001
EuroQol-index	0.29 (0.27–0.31)	0.26 (0.25–0.27)	0.02	0.69 (0.68–0.71)	0.70 (0.70–0.71)	0.4
EuroQol-VAS	47 (46–49)	45 (44–45)	0.006	68 (67–69)	71 (70–71)	< 0.001
SF-36
PF	31 (30–33)	39 (38–39)	< 0.001	60 (58–61)	74 (74–74)	< 0.001
RP	6 (5–7)	9 (8–9)	< 0.001	46 (43–48)	58 (58–59)	< 0.001
BP	22 (21–23)	22 (22–22)	0.5	58 (57–60)	60 (60–61)	0.02
GH	61 (60–62)	67 (67–67)	< 0.001	62 (61–64)	68 (68–68)	< 0.001
VT	37 (36–38)	34 (33–34)	< 0.001	59 (57–60)	57 (57–58)	0.2
SF	48 (46–49)	47 (46–48)	0.6	78 (76–79)	80 (79–80)	0.02
RE	30 (27–32)	42 (41–43)	< 0.001	62 (60–65)	74 (73–75)	< 0.001
MH	61 (59–62)	60 (59–60)	0.1	75 (74–76)	75 (74–75)	0.6
PCS	37 (36–38)	36 (36–37)	0.3	46 (45–46)	46 (46–46)	0.2
MCS	28 (28–29)	31 (31–32)	< 0.001	40 (39–40)	44 (44–44)	< 0.001
ODI	50 (49–51)	49 (48–49)	0.005	24 (22–25)	20 (20–20)	< 0.001

SF-36 scales: PF – physical functioning, RP – physical role functioning, BP – bodily pain, GH – general health perceptions, VT – vitality, SF – social role functioning, EM – emotional role functioning, MH – mental health, PCS – physical component summary, and MCS – mental component summary.

ODI: Oswestry disability index

Figure 2. 1-year postoperative estimated point defi cit in quality of life estimated by SF-36, in elderly and younger patients operated for LDH compared to a published age-matched reference data population (Sullivan et al. 1994). Elderly is defi ned as patients aged ≥65 years of age, and younger refers to the sex-matched comparison group aged 20–64. For Abbreviations, see Table 3.

Table 4. Improvements from preoperatively to 1-year postoperatively in VAS as an estimation of back and leg pain, EuroQol and SF-36 as estimations of quality of life, and ODI as an estimation of disability. Data are mean (95% CI) or percentages. Elderly is defined as those aged ≥65 years, and younger refers to the sex-matched comparison group aged 20–64

	Improvement by surgery
	Elderly	Younger	p-value
VAS back pain	27 (25–29)	22 (21–23)	0.003
VAS leg pain	40 (38–42)	45 (44–46)	< 0.001
EuroQol-index	0.42 (0.40–0.45)	0.45 (0.44–0.46)	< 0.05
EuroQol-VAS	22 (20–24)	26 (26–27)	< 0.001
SF-36
PF	29 (27–31)	36 (36–37)	< 0.001
RP	42 (39–45)	51 (50–52)	< 0.001
BP	37 (35–39)	39 (38–40)	0.03
GH	2 (0–3)	2 (1–2)	0.8
VT	22 (20–24)	25 (24–25)	0.008
SF	31 (29–33)	34 (33–34)	0.02
RE	33 (30–37)	33 (32–34)	0.7
MH	15 (14–16)	16 (15–16)	0.3
PCS	9 (8–10)	10 (10–10)	0.03
MCS	12 (11–12)	13 (13–13)	0.004
ODI	28 (26–29)	29 (29–29)	0.1
Satisfaction, %			0.04
Satisfied/indeterminate	91	92
Dissatisfied	9.3	7.6

For Abbreviations, see Table 3.

Sullivan M, Karlsson J, Ware J E, Jr. SF-36 hälsoenkät : svensk manual och tolkningsguide. Book 1994.

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