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

Pradeep Suri, David J. Hunter, Cristin Jouve, Carol Hartigan, Janet Limke, Enrique Pena, Ling Li, Jennifer Luz, James Rainville

• 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.