Lumbar Disc Surgery in Elderly

ABSTRACT

By virtue of modern neuroimaging, neurosurgeons are increasingly confronted by patients once deemed too old for lumbar disc herniation. Management of these patients is problematic, as the literature is relatively mute in regard to results and complications within this group. So, the purpose of this study is to review our experience in surgical treatment of elderly patients with this disorder and to provide a surgical reference for elderly regarding the safety of this surgery in terms of adverse perioperative events, duration of surgery, blood loss, surgery-related complications and hospital length of stay. The study included 45 patients in Suez Canal University Hospital from January 2003 to January 2005 diagnosed with lumbar disc prolapse and documented with MRI. The mean age was 66.5 years, 42% were females, 58% were males. The duration of follow up included short-term [1month] and long-term [9months]. The short-term results showed 90% success of pain relief [leg pain], while the long-term results obtained from patient questionnaire showed leg pain relief 85%, back pain relief 80%, satisfaction with surgery 82%, but return to activity 65% [lowest success rate]. The mean time spent in the hospital was 7.1 +/- 2 days postoperatively and the rate of significant complications was 8% [one case of CSF leak treated without surgery and three cases of wound infection lasted three weeks postoperatively for medical treatment]. Lumbar discectomy is relatively safe and highly effective in the elderly patients, with highly prevalent need for decompression of stenotic spine in addition to herniated disc. To resolve a persistently high failure rate we still need better patient selection and meticulous technique