Skip to main content

Advertisement

SpringerLink
Log in

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

  • Original Article
  • Published:
European Spine Journal Aims and scope Submit manuscript

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.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3

Similar content being viewed by others

References

  1. Jordon J, Konstantinou K, O’Dowd J (2009) Herniated lumbar disc. BMJ Clin Evid 2009:1118

    PubMed Central  Google Scholar 

  2. 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

    Article  Google Scholar 

  3. Matuda KYS, Suezawa N, Yonezawa H, Shubata T (1962) Clinical results of lumbar disc herniation. Seikeigeka 13:589–595

    Google Scholar 

  4. Nakahara SKH, Nasu M (1984) Surgical results of lumbar disc herniation in the aged. Chubuseisaisi 27:110–112

    Google Scholar 

  5. 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 68:50–53

    Article  CAS  PubMed  Google Scholar 

  6. 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

    Google Scholar 

  7. 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

    Article  CAS  PubMed  Google Scholar 

  8. Spangfort EV (1972) The lumbar disc herniation. A computer-aided analysis of 2,504 operations. Acta Orthop Scand Suppl 142:1–95

    Article  CAS  PubMed  Google Scholar 

  9. Weber H (1983) Lumbar disc herniation. A controlled, prospective study with 10 years of observation. Spine 8:131–140

    Article  CAS  PubMed  Google Scholar 

  10. 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

    Article  PubMed  PubMed Central  Google Scholar 

  11. 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 3:143–146

    Article  CAS  PubMed  Google Scholar 

  12. 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 85:1146–1150

    Article  CAS  PubMed  Google Scholar 

  13. Maistrelli GL, Vaughan PA, Evans DC, Barrington TW (1987) Lumbar disc herniation in the elderly. Spine 12:63–66

    Article  CAS  PubMed  Google Scholar 

  14. Solberg T, Johnsen LG, Nygaard OP, Grotle M (2013) Can we define success criteria for lumbar disc surgery?: estimates for a substantial amount of improvement in core outcome measures. Acta Orthop 84:196–201. doi:10.3109/17453674.2013.786634

    Article  PubMed  PubMed Central  Google Scholar 

  15. Stromqvist F, Ahmad M, Hildingsson C, Jonsson B, Stromqvist B (2008) Gender differences in lumbar disc herniation surgery. Acta Orthop 79:643–649. doi:10.1080/17453670810016669

    Article  PubMed  Google Scholar 

  16. Peul WC, Brand R, Thomeer RT, Koes BW (2008) Influence of gender and other prognostic factors on outcome of sciatica. Pain 138:180–191. doi:10.1016/j.pain.2007.12.014

    Article  PubMed  Google Scholar 

  17. Stromqvist B (2002) Evidence-based lumbar spine surgery. The role of national registration. Acta Orthop Scand Suppl 73:34–39

    Article  PubMed  Google Scholar 

  18. 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

    Article  Google Scholar 

  19. Stromqvist B, Jonsson B, Fritzell P, Hagg O, Larsson BE, Lind B (2001) The Swedish National Register for lumbar spine surgery: Swedish Society for Spinal Surgery. Acta Orthop Scand 72:99–106. doi:10.1080/000164701317323327

    Article  CAS  PubMed  Google Scholar 

  20. 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. Fairbank JC, Couper J, Davies JB, O’Brien JP (1980) The Oswestry low back pain disability questionnaire. Physiotherapy 66:271–273

    CAS  PubMed  Google Scholar 

  22. Fairbank JC, Pynsent PB (2000) The oswestry disability index. Spine 25:2940–2952 (discussion 2952)

    Article  CAS  PubMed  Google Scholar 

  23. 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

    Google Scholar 

  24. 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

    Google Scholar 

  25. 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

    Google Scholar 

  26. 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

    Google Scholar 

  27. 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

    Article  Google Scholar 

  28. 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 83:201–209

    Article  CAS  PubMed  Google Scholar 

  29. 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 25:937–940

    Article  CAS  PubMed  Google Scholar 

  30. Dammers R, Koehler PJ (2002) Lumbar disc herniation: level increases with age. Surg Neurol 58:209–212 (discussion 212–203)

    Article  PubMed  Google Scholar 

  31. 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 18:1456–1462

    Article  CAS  PubMed  Google Scholar 

  32. Harada Y, Nakahara S (1989) A pathologic study of lumbar disc herniation in the elderly. Spine 14:1020–1024

    Article  CAS  PubMed  Google Scholar 

  33. 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

    Article  Google Scholar 

  34. Shillito J Jr (1996) Pediatric lumbar disc surgery: 20 patients under 15 years of age. Surg Neurol 46:14–18

    Article  PubMed  Google Scholar 

  35. Rainville J, Lopez E (2013) Comparison of radicular symptoms caused by lumbar disc herniation and lumbar spinal stenosis in the elderly. Spine 38:1282–1287. doi:10.1097/BRS.0b013e31828f463e

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Departments of Clinical Sciences and Orthopaedics, Clinical and Molecular Osteoporosis Research Unit, Skane University Hospital, Lund University, Malmö, Sweden

    Fredrik Strömqvist, Björn Strömqvist, Bo Jönsson & Magnus K. Karlsson

  2. Department of Orthopaedics, Skane University Hospital, 205 02, Malmo, Sweden

    Fredrik Strömqvist

Authors
  1. Fredrik Strömqvist
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Björn Strömqvist
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Bo Jönsson
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Magnus K. Karlsson
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Fredrik Strömqvist.

Ethics declarations

Conflicts of interest

None of the authors has any potential conflict of interest.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Strömqvist, F., Strömqvist, B., Jönsson, B. et al. Gender differences in the surgical treatment of lumbar disc herniation in elderly. Eur Spine J 25, 3528–3535 (2016). https://doi.org/10.1007/s00586-016-4638-6

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00586-016-4638-6

Keywords

Search

Navigation