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Abstract
Objectives
To evaluate the clinical picture and surgical outcome of a lumbar disc herniation in elderly patients.
Summary of Literature Review
Lumbar disc herniation is less common in older persons, but there has been an increasing con-cern in elderly patients.
Materials and Methods
A retrospective review evaluated 34 patients (men:12, female:22) over 65 years old or with a T score -2.5 or below below on the BMD and/or over 60 years old with systemic comorbid disease who underwent surgery for a lumbar disc herniation between January 1991and June 2001. All patients had at least a 2- year followup evaluation. They were analyzed for their physical status, comorbid condition, preoperative, followup symptoms and signs, the longterm clinical outcome based on the A SA (A merican society of anesthesiology) class and operative findings.
Results
There were 7 A SA class I patients, 22 A SA class II patients, 5 A SA class III patients, and comorbidity was found in 20 patients. Higher rates of negative straight leg raising were observed in the elderly patients compared to the younger patients, and 8 patients had a neurological claudication history. 25 patients had excellent or good results and better results were obtained with the sequestration and extrusion type, respectively, as compared with protrusion type. However, there was no correlation between the A SA class, postoperative complications, and clinical outcome.
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REFERENCES
1). Barr JS, Riseborough EJ. Treatment of low back and sciatic pain in patients over 60 years of age: a study of 100 patients. Clin Orthop. 1963; 26:12–18.
2). Yasuma T, Koh S, Okamura T, Yamauchi Y. Histologi -cal changes in aging lumbar intervertebral discs. J Bone Joint Surg. 1990; 72A:220–229.
3). Rhyu KW, Kang YK, Lee HY, Koh HS, Choi JH. Lumbar disc herniation in elderly patients. J Kor Orthop Assoc. 1996; 3:132–137.
4). Lee HM, Kang YH, Kim HG. Herniated lumbar disc in patients over the age of sixty. J Kor Orthop Assoc. 1997; 4:143–148.
5). Fernbach JC, Langer F, Gross AE. The significance of low back pain in older adults. Can Med Assoc J. 1976; 115:898–900.
6). Gembun Y, Nakayama Y, Shirai Y, Miyamoto M, Kitagawa Y, Yamada T. Surgical results of lumbar disc herniation in the elderly. J Nippon Med Sch. 2001; 68:50–53.
7). Maistrelli GL, Vaughan PA, Evans DC, Barrington T W. Lumbar disc herniation in the elderly. Spine. 1987; 12:63–66.
8). Rothoerl RD, Woertgen C, Holzschuh M, Schlaier J. Are there differences in the symptoms, signs and outcome after lumbar disc surgery in the elderly compared with younger patients? Br J Neurosurg. 1998; 12:250–253.
9). Simon SD, Silver CM, Litchman HM. Lumbar disc surgery in the elderly. Clin Orthop. 1965; 41:157–162.
10). Shim DM, Kim SS, Kim TG, Song HH, Choi SH. Results ofmicroscopic discectomy in lumbar disc herniation: a 5 years follow up. J Kor Orthop Assoc. 2000; 7:22–28.
11). Kim NH, Seo IK. The effect of anterior interbody fusion in lumbar herniated nucleus pulposus. J Kor Orthop Assoc. 1986; 21:202–209.
12). Weber H. Lumbar disc herniation. A controlled, prospective study with ten years of observation. Spine. 1983; 8:131–140.
13). Atlas SJ, Chang Y, Kammann E, Keller RB, Deyo RA, Singer DE. Longterm disability and return to work among patients who have a herniated lumbar disc: the effect of disability compensation. J Bone Joint Surg. 2000; 82A:4–15.
14). Gibson JN, Grant IC, Waddell G. The Cochrane review of surgery for lumbar disc prolapse and degenerative lumbar spondylosis. Spine. 1999; 24:1820–1832.
15). Deyo RA, Cherkin DC, Loeser JD, Bigos SJ, Ciol MA. Morbidity and mortality in association with operations on the lumbar spine: The influence of age, diagnosis, and procedure. J Bone Joint Surg. 1992; 74A:536–543.
16). Ragab AA, Fye MA, Bohlman HH. Surgery of lumbar spine for spinal stenosis in 118 patients 70 years of age or older. Spine. 2003; 28:348–353.
17). Simpson JM, Silveri CP, Balderston RA, Simeone FA, An HS. The results of operations on the lumbar spine in patients who have diabetes mellitus. J Bone Joint Surg. 1993; 75A:1823–1829.
18). Cinotti G, Postacchini F, Weinstein JN. Lumbar spinal stenosis and diabetes: Outcome of surgical decompression. J Bone Joint Surg. 1994; 76B:215–219.
19). An HS, Vaccaro A, Simeone FA, Balderston RA, O’ Neill D. Herniated lumbar disc in patients over the age of fifty. J Spinal Disord. 1990; 3:143–146.
20). Jonsson B, Stromqvist B. Influence of age on symptoms and signs in lumbar disc herniation. Eur Spine J. 1995; 4:202–205.
21). Dammers R, Koehler PJ. Lumbar disc herniation: level increases with age. Surg Neurol. 2002; 58:209–212.
22). Li Q, Tian W, Liu B, Hu L, Li Z. Characteristics of perioperative lumbar operation for the elderly. Zhonghua Wai Ke Za Zhi. 2002; 40:448–450.
23). Tanaka M, Nakahara S, Inoue H. A pathologic study of discs in the elderly. Separation between the cartilaginous endplate and the vertebral body. Spine. 1993; 18:1456–1462.
24). Di Silvestre M, Greggi T, Rulli E, Paderni S, Palumbi P, Parisini P. Lumbar disc herniation in the elderly patient. Chir Organi Mov. 2001; 86:223–230.
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Table 1.
Involved Segments
| Segment | No. of Patients (%) |
|---|---|
| L1-2 | 2 (5.9 %) |
| L2-3 | 4 (11.8 %) |
| L3-4 | 3 (8.8 %) |
| L4-5 | 12 (35.3 %) |
| L5-S1 | 9 (26.5 %) |
| L3-4 / L4-5 | 1 (2.9 %) |
| L4-5 / L5-S1 | 3 (8.8 %) |
| Total | 34 (100 %) |
Table 2.
Distribution complications relevant to ASA# class
| ASA Class | Ⅰ | Ⅱ | Ⅲ | Ⅳ |
|---|---|---|---|---|
| No. of Patients | 7 | 22 | 5 | |
| Complications | ||||
| hypotension | 1 | 1 | 1 | |
| urinary retension | 1 | 1 | 1 | |
| confusion | 2 | 1 | ||
| wound infection | 1 | |||
| hemartoma | 1 | |||
| dura tear | 1 | |||
| No. of Complications | 2 | 7 | 3 | |
Table 3.
Comparison of Preoperative and F/U physical findings
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