Skip to main content
Top
Published in: European Spine Journal 11/2016

01-11-2016 | Original Article

Gender differences in the surgical treatment of lumbar disc herniation in elderly

Authors: Fredrik Strömqvist, Björn Strömqvist, Bo Jönsson, Magnus K. Karlsson

Published in: European Spine Journal | Issue 11/2016

Login to get access

Abstract

Purpose

Outcome after lumbar disc herniation (LDH) surgery in middle-aged patient is usually reported to fulfill the criteria for successful outcome. It is also known that women in these years have an inferior outcome compared to men. This study evaluates whether the same gender differences exist in elderly.

Method

In the national Swedish register for spine surgery (SweSpine) we identified 1668 patients ≥65 years. 1250 of these patients had both pre- and 1-year postoperative data registered, 53 % males with mean age 70.6 ± 5.0 (mean ± SD) and 47 % females with mean age 71.3 ± 5.2. All were surgically treated due to LDH between 2000 and 2012.

Results

Before surgery both men and women had severe impairment, compared to normative data, in all patient-reported outcome measures (PROMs), with women having inferior status to men. Improvement by surgery was similar in both genders but neither of them reached normative values in quality of life as compared to normative age-matched individuals. As a consequence of this women 1 year after surgery had more back and leg pain, higher consumption of analgesics, greater impairment in walking distance and inferior scoring in virtually all registered PROMs compared to men (all p < 0.005). In spite of this women were as satisfied with the surgical outcome as the men.

Conclusion

Elderly women with LDH surgery report inferior outcome compared to males, mainly as a result of being referred to surgery with an inferior status but are despite this as satisfied with outcome as the men.
Literature
1.
2.
go back to reference Stromqvist B, Fritzell P, Hagg O, Jonsson B, Sanden B, Swedish Society of Spinal S (2013) Swespine: the Swedish spine register: the 2012 report. Eur Spine J Off Publ Eur Spine Soc Eur Spinal Deform Soc Eur Sect Cerv Spine Res Soc 22:953–974. doi:10.1007/s00586-013-2758-9 CrossRef Stromqvist B, Fritzell P, Hagg O, Jonsson B, Sanden B, Swedish Society of Spinal S (2013) Swespine: the Swedish spine register: the 2012 report. Eur Spine J Off Publ Eur Spine Soc Eur Spinal Deform Soc Eur Sect Cerv Spine Res Soc 22:953–974. doi:10.​1007/​s00586-013-2758-9 CrossRef
3.
go back to reference Matuda KYS, Suezawa N, Yonezawa H, Shubata T (1962) Clinical results of lumbar disc herniation. Seikeigeka 13:589–595 Matuda KYS, Suezawa N, Yonezawa H, Shubata T (1962) Clinical results of lumbar disc herniation. Seikeigeka 13:589–595
4.
go back to reference Nakahara SKH, Nasu M (1984) Surgical results of lumbar disc herniation in the aged. Chubuseisaisi 27:110–112 Nakahara SKH, Nasu M (1984) Surgical results of lumbar disc herniation in the aged. Chubuseisaisi 27:110–112
5.
go back to reference Gembun Y, Nakayama Y, Shirai Y, Miyamoto M, Kitagawa Y, Yamada T (2001) Surgical results of lumbar disc herniation in the elderly. J Nippon Med Sch Nippon Ika Daigaku Zasshi 68:50–53CrossRefPubMed Gembun Y, Nakayama Y, Shirai Y, Miyamoto M, Kitagawa Y, Yamada T (2001) Surgical results of lumbar disc herniation in the elderly. J Nippon Med Sch Nippon Ika Daigaku Zasshi 68:50–53CrossRefPubMed
6.
go back to reference Di Silvestre M, Greggi T, Rulli E, Paderni S, Palumbi P, Parisini P (2001) Lumbar disc herniation in the elderly patient. La Chir Degli Org Mov 86:223–230 Di Silvestre M, Greggi T, Rulli E, Paderni S, Palumbi P, Parisini P (2001) Lumbar disc herniation in the elderly patient. La Chir Degli Org Mov 86:223–230
7.
go back to reference Peul WC, van Houwelingen HC, van den Hout WB, Brand R, Eekhof JA, Tans JT, Thomeer RT, Koes BW, Leiden-The Hague Spine Intervention Prognostic Study G (2007) Surgery versus prolonged conservative treatment for sciatica. N Engl J Med 356:2245–2256. doi:10.1056/NEJMoa064039 CrossRefPubMed Peul WC, van Houwelingen HC, van den Hout WB, Brand R, Eekhof JA, Tans JT, Thomeer RT, Koes BW, Leiden-The Hague Spine Intervention Prognostic Study G (2007) Surgery versus prolonged conservative treatment for sciatica. N Engl J Med 356:2245–2256. doi:10.​1056/​NEJMoa064039 CrossRefPubMed
8.
go back to reference Spangfort EV (1972) The lumbar disc herniation. A computer-aided analysis of 2,504 operations. Acta Orthop Scand Suppl 142:1–95CrossRefPubMed Spangfort EV (1972) The lumbar disc herniation. A computer-aided analysis of 2,504 operations. Acta Orthop Scand Suppl 142:1–95CrossRefPubMed
9.
go back to reference Weber H (1983) Lumbar disc herniation. A controlled, prospective study with 10 years of observation. Spine 8:131–140CrossRefPubMed Weber H (1983) Lumbar disc herniation. A controlled, prospective study with 10 years of observation. Spine 8:131–140CrossRefPubMed
10.
go back to reference Weinstein JN, Lurie JD, Tosteson TD, Tosteson AN, Blood EA, Abdu WA, Herkowitz H, Hilibrand A, Albert T, Fischgrund J (2008) Surgical versus nonoperative treatment for lumbar disc herniation: 4-year results for the Spine Patient Outcomes Research Trial (SPORT). Spine 33:2789–2800. doi:10.1097/BRS.0b013e31818ed8f4 CrossRefPubMedPubMedCentral Weinstein JN, Lurie JD, Tosteson TD, Tosteson AN, Blood EA, Abdu WA, Herkowitz H, Hilibrand A, Albert T, Fischgrund J (2008) Surgical versus nonoperative treatment for lumbar disc herniation: 4-year results for the Spine Patient Outcomes Research Trial (SPORT). Spine 33:2789–2800. doi:10.​1097/​BRS.​0b013e31818ed8f4​ CrossRefPubMedPubMedCentral
11.
go back to reference An HS, Vaccaro A, Simeone FA, Balderston RA, O’Neill D (1990) Herniated lumbar disc in patients over the age of fifty. J Spinal Disord 3:143–146CrossRefPubMed An HS, Vaccaro A, Simeone FA, Balderston RA, O’Neill D (1990) Herniated lumbar disc in patients over the age of fifty. J Spinal Disord 3:143–146CrossRefPubMed
12.
go back to reference Fujii K, Henmi T, Kanematsu Y, Mishiro T, Sakai T (2003) Surgical treatment of lumbar disc herniation in elderly patients. J Bone Joint Surg Br 85:1146–1150CrossRefPubMed Fujii K, Henmi T, Kanematsu Y, Mishiro T, Sakai T (2003) Surgical treatment of lumbar disc herniation in elderly patients. J Bone Joint Surg Br 85:1146–1150CrossRefPubMed
13.
go back to reference Maistrelli GL, Vaughan PA, Evans DC, Barrington TW (1987) Lumbar disc herniation in the elderly. Spine 12:63–66CrossRefPubMed Maistrelli GL, Vaughan PA, Evans DC, Barrington TW (1987) Lumbar disc herniation in the elderly. Spine 12:63–66CrossRefPubMed
17.
go back to reference Stromqvist B (2002) Evidence-based lumbar spine surgery. The role of national registration. Acta Orthop Scand Suppl 73:34–39CrossRefPubMed Stromqvist B (2002) Evidence-based lumbar spine surgery. The role of national registration. Acta Orthop Scand Suppl 73:34–39CrossRefPubMed
18.
go back to reference Stromqvist B, Fritzell P, Hagg O, Jonsson B, Swedish Society of Spinal S (2009) The Swedish Spine Register: development, design and utility. Eur Spine J Off Publ Eur Spine Soc Eur Spinal Deform Soci Eur Sect Cerv Spine Res Soc 18(Suppl 3):294–304. doi:10.1007/s00586-009-1043-4 CrossRef Stromqvist B, Fritzell P, Hagg O, Jonsson B, Swedish Society of Spinal S (2009) The Swedish Spine Register: development, design and utility. Eur Spine J Off Publ Eur Spine Soc Eur Spinal Deform Soci Eur Sect Cerv Spine Res Soc 18(Suppl 3):294–304. doi:10.​1007/​s00586-009-1043-4 CrossRef
20.
go back to reference Sullivan M, Karlsson J, Taft C, Ware JE (2002) SF-36 Hälsoenkät: Svensk manual och tolkningsguide, 2:a upplagan (Swedish Manual and Interpretation Guide, 2nd edition). Sahlgrenska University Hospital, Gothenburg Sullivan M, Karlsson J, Taft C, Ware JE (2002) SF-36 Hälsoenkät: Svensk manual och tolkningsguide, 2:a upplagan (Swedish Manual and Interpretation Guide, 2nd edition). Sahlgrenska University Hospital, Gothenburg
21.
go back to reference Fairbank JC, Couper J, Davies JB, O’Brien JP (1980) The Oswestry low back pain disability questionnaire. Physiotherapy 66:271–273PubMed Fairbank JC, Couper J, Davies JB, O’Brien JP (1980) The Oswestry low back pain disability questionnaire. Physiotherapy 66:271–273PubMed
22.
go back to reference Fairbank JC, Pynsent PB (2000) The oswestry disability index. Spine 25:2940–2952 (discussion 2952) CrossRefPubMed Fairbank JC, Pynsent PB (2000) The oswestry disability index. Spine 25:2940–2952 (discussion 2952) CrossRefPubMed
23.
go back to reference Stromqvist F, Stromqvist B, Jonsson B, Karlsson MK (2015) Gender differences in patients scheduled for lumbar disc herniation surgery: a National Register Study including 15,631 operations. Eur Spine J Off Publ Eur Spine Soc Eur Spinal Deform Soc Eur Sect Cerv Spine Res Soc. doi:10.1007/s00586-015-4052-5 Stromqvist F, Stromqvist B, Jonsson B, Karlsson MK (2015) Gender differences in patients scheduled for lumbar disc herniation surgery: a National Register Study including 15,631 operations. Eur Spine J Off Publ Eur Spine Soc Eur Spinal Deform Soc Eur Sect Cerv Spine Res Soc. doi:10.​1007/​s00586-015-4052-5
24.
go back to reference Pochon L, Kleinstuck FS, Porchet F, Mannion AF (2015) Influence of gender on patient-oriented outcomes in spine surgery. Eur Spine J Off Publ Eur Spine Soc Eur Spinal Deform Soc Eur Sect Cerv Spine Res Soc. doi:10.1007/s00586-015-4062-3 Pochon L, Kleinstuck FS, Porchet F, Mannion AF (2015) Influence of gender on patient-oriented outcomes in spine surgery. Eur Spine J Off Publ Eur Spine Soc Eur Spinal Deform Soc Eur Sect Cerv Spine Res Soc. doi:10.​1007/​s00586-015-4062-3
25.
go back to reference Kim HJ, Suh BG, Lee DB, Park JY, Kang KT, Chang BS, Lee CK, Yeom JS (2013) Gender difference of symptom severity in lumbar spinal stenosis: role of pain sensitivity. Pain Phys 16:E715–E723 Kim HJ, Suh BG, Lee DB, Park JY, Kang KT, Chang BS, Lee CK, Yeom JS (2013) Gender difference of symptom severity in lumbar spinal stenosis: role of pain sensitivity. Pain Phys 16:E715–E723
26.
go back to reference Kim HJ, Suh BG, Lee DB, Lee GW, Kim DW, Kang KT, Chang BS, Lee CK, Yeom JS (2013) The influence of pain sensitivity on the symptom severity in patients with lumbar spinal stenosis. Pain Phys 16:135–144 Kim HJ, Suh BG, Lee DB, Lee GW, Kim DW, Kang KT, Chang BS, Lee CK, Yeom JS (2013) The influence of pain sensitivity on the symptom severity in patients with lumbar spinal stenosis. Pain Phys 16:135–144
27.
go back to reference Kim HJ, Cho CH, Kang KT, Chang BS, Lee CK, Yeom JS (2015) The significance of pain catastrophizing in clinical manifestations of patients with lumbar spinal stenosis: mediation analysis with bootstrapping. Spine J Off J N Am Spine Soc 15:238–246. doi:10.1016/j.spinee.2014.09.002 CrossRef Kim HJ, Cho CH, Kang KT, Chang BS, Lee CK, Yeom JS (2015) The significance of pain catastrophizing in clinical manifestations of patients with lumbar spinal stenosis: mediation analysis with bootstrapping. Spine J Off J N Am Spine Soc 15:238–246. doi:10.​1016/​j.​spinee.​2014.​09.​002 CrossRef
28.
go back to reference Bronfort G, Bouter LM (1999) Responsiveness of general health status in chronic low back pain: a comparison of the COOP charts and the SF-36. Pain 83:201–209CrossRefPubMed Bronfort G, Bouter LM (1999) Responsiveness of general health status in chronic low back pain: a comparison of the COOP charts and the SF-36. Pain 83:201–209CrossRefPubMed
29.
go back to reference Hasegawa T, An HS, Inufusa A, Mikawa Y, Watanabe R (2000) The effect of age on inflammatory responses and nerve root injuries after lumbar disc herniation: an experimental study in a canine model. Spine 25:937–940CrossRefPubMed Hasegawa T, An HS, Inufusa A, Mikawa Y, Watanabe R (2000) The effect of age on inflammatory responses and nerve root injuries after lumbar disc herniation: an experimental study in a canine model. Spine 25:937–940CrossRefPubMed
30.
go back to reference Dammers R, Koehler PJ (2002) Lumbar disc herniation: level increases with age. Surg Neurol 58:209–212 (discussion 212–203) CrossRefPubMed Dammers R, Koehler PJ (2002) Lumbar disc herniation: level increases with age. Surg Neurol 58:209–212 (discussion 212–203) CrossRefPubMed
31.
go back to reference Tanaka M, Nakahara S, Inoue H (1993) A pathologic study of discs in the elderly. Separation between the cartilaginous endplate and the vertebral body. Spine 18:1456–1462CrossRefPubMed Tanaka M, Nakahara S, Inoue H (1993) A pathologic study of discs in the elderly. Separation between the cartilaginous endplate and the vertebral body. Spine 18:1456–1462CrossRefPubMed
32.
go back to reference Harada Y, Nakahara S (1989) A pathologic study of lumbar disc herniation in the elderly. Spine 14:1020–1024CrossRefPubMed Harada Y, Nakahara S (1989) A pathologic study of lumbar disc herniation in the elderly. Spine 14:1020–1024CrossRefPubMed
33.
go back to reference Kumar R, Kumar V, Das NK, Behari S, Mahapatra AK (2007) Adolescent lumbar disc disease: findings and outcome. Child’s Nerv Syst ChNS Off J Int Soc Pediatric Neurosurg 23:1295–1299. doi:10.1007/s00381-007-0370-1 CrossRef Kumar R, Kumar V, Das NK, Behari S, Mahapatra AK (2007) Adolescent lumbar disc disease: findings and outcome. Child’s Nerv Syst ChNS Off J Int Soc Pediatric Neurosurg 23:1295–1299. doi:10.​1007/​s00381-007-0370-1 CrossRef
34.
go back to reference Shillito J Jr (1996) Pediatric lumbar disc surgery: 20 patients under 15 years of age. Surg Neurol 46:14–18CrossRefPubMed Shillito J Jr (1996) Pediatric lumbar disc surgery: 20 patients under 15 years of age. Surg Neurol 46:14–18CrossRefPubMed
Metadata
Title
Gender differences in the surgical treatment of lumbar disc herniation in elderly
Authors
Fredrik Strömqvist
Björn Strömqvist
Bo Jönsson
Magnus K. Karlsson
Publication date
01-11-2016
Publisher
Springer Berlin Heidelberg
Published in
European Spine Journal / Issue 11/2016
Print ISSN: 0940-6719
Electronic ISSN: 1432-0932
DOI
https://doi.org/10.1007/s00586-016-4638-6

Other articles of this Issue 11/2016

European Spine Journal 11/2016 Go to the issue