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Nonsurgical Treatment of Lumbar Disk Herniation: Are Outcomes Different in Older Adults?
Author(s) -
Suri Pradeep,
Hunter David J.,
Jouve Cristin,
Hartigan Carol,
Limke Janet,
Pena Enrique,
Li Ling,
Luz Jennifer,
Rainville James
Publication year - 2011
Publication title -
journal of the american geriatrics society
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.992
H-Index - 232
eISSN - 1532-5415
pISSN - 0002-8614
DOI - 10.1111/j.1532-5415.2011.03316.x
Subject(s) - medicine , oswestry disability index , low back pain , physical therapy , radicular pain , sciatica , prospective cohort study , confounding , cohort study , cohort , young adult , back pain , lumbar , longitudinal study , surgery , alternative medicine , pathology
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.