Comparative analysis of treatment results in patients with disс herniation of different age groups

Objective. To perform comparative analysis of the results of surgical treatment of patients with intervertebral disc herniation of different age groups.

Material and Methods. The results of treatment of 2,448 patients (1,307 men and 1,141 women) with lumbar intervertebral disc herniation were analyzed. Out of them, 393 (16 %) people were elderly and senile patients with a mean age of 66 years. Evaluation of the treatment results in patients with herniated intervertebral discs was carried out in two groups: Group I – young and middle-aged patients; and Group II – elderly and senile patients. Mandatory preoperative evaluation included clinical and neurological examination, radiation diagnostic methods (X-ray, CT, CT-myelography, MRI), and survey using scales and questionnaires (VAS, ODI, CCI).

Results. Body mass index (BMI), blood loss, duration of surgery, and length of hospital stay were statistically significantly greater in patients of Group II. In terms of pain, quality of life before and within 5 years after surgical treatment, patients of groups I and II have no statistically significant differences. The total complication rate was 4.9 %, while in patients of Group II complications developed statistically significantly more often (1.7 times) than in patients of Group I (p = 0.02). The most common complication was unintentional durotomy, which occurred in 3.6 % of cases, without statistically significant differences between groups. Epidural hematomas requiring revision intervention were observed in 13 patients, statistically significantly more often in patients of Group II (p = 0.04). The volume of blood loss in patients of Group II is significantly greater (p < 0.001). The cumulative index of reoperations over the 5-year follow-up period in Group I was 11.5 %, in Group II – 13.6 %. During the first year, reoperations in Group I amounted to 6.0 %, in Group II – 8.7 % (p = 0.05), which indicates the possible effect of age on the frequency of repeated operations. Convincing data on the effect of BMI and the comorbidity index on this indicator have not been obtained. The most common cause of reoperation in patients with herniated discs in both groups was hernia recurrence at the operated level, while the relapse rate in Group II was slightly higher – 46 % (n = 37) compared with 36 % (n = 168) in Group I.

Conclusion. No difference was found between the clinical outcomes of surgical treatment of herniated intervertebral discs in patients of different age groups during a 5-year follow-up period. Elderly and senile age is a predictor of a higher frequency of early and intraoperative complications, an increase in the surgery duration and in the volume of intraoperative blood loss. Obesity and concomitant somatic pathology do not affect the clinical outcomes of surgical treatment and the cumulative index of repeated operations in patients with herniated discs of the lumbar spine.

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