Clinical Outcomes of Discectomy in Octogenarian Patients With Lumbar Disc Herniation

Study Design: A retrospective clinical study. Objective: To investigate the efficacy and safety of surgery for lumbar disc herniation in octogenarian patients. Summary of Background Data: Lumbar disc protrusion in the very elderly becomes more common with the aging of the general population, but few patients undergo surgical treatment because the chronological age of 80 years or more has long been considered a contraindication to elective spine surgery. Thus, there is little information about acute and long-term outcomes of lumbar discectomy in octogenarians, and the influence of age on outcome after surgery still remains controversial. Methods: Sixty-four octogenarian patients with lumbar disc herniation underwent unilateral laminectomy and discectomy between January 2004 and June 2010. Operative time (OT), intraoperative estimated blood loss (EBL), length of hospital stay (LOS), and complication rate (CR) were used to assess the safety of surgery. The visual analog scale (VAS), the Oswestry disability index (ODI), and the North American Spine Society Outcome Questionnaire were used to evaluate clinical effectiveness. Results: Significant differences were found between the very elderly and the middle-aged group in LOS (P < 0.001) but not in OT, EBL, and CR (all P > 0.05). The preoperative, postoperative, and final follow-up VAS and ODI scores were not significantly different between the 2 groups (each P > 0.05). However, the VAS and ODI scores significantly improved after surgery and at final follow-up compared with those before surgery (all P < 0.001). Satisfaction with outcome was expressed by 57 (89.1%) of 64 very elderly patients. Conclusions: Discectomy through hemilaminectomy is a feasible, safe, and effective treatment procedure in octogenarian patients with lumbar disc herniation. Disc resection in octogenarian patients usually gives good or excellent results. Careful examination of the surgical indications and attentive perioperative management should be considered for this patient population.