Acute disc herniation in the elderly

Background. Acute disc prolapse in young adults has been studied extensively. However, little is known about acute disc prolapse in the elderly. Objective. We aimed to define the features of acute disc prolapse in the elderly. Design, setting and patients. Elderly (>= 65 years) patients who had lumbar or thoracic discectomy for acute (< 3 months) disc prolapse in our unit between July 2004 and March 2010 were identified. For comparison, we used a 'young' (25-45 years) patient cohort with acute thoracic or lumbar disc prolapse. Data collected included age, symptom onset, preoperative signs and spinal level. Results. During the study period, 390 patients had discectomy, of which 59.7% were 'young' and 7.4% 'elderly'. The young and elderly patients had significantly different distributions of prolapsed disc levels. In the young, 97% of all disc protrusions were at L4/5 or L5/S1, but < 50% were at these levels in the elderly. In the elderly, about 10% of disc protrusions were thoracic. Conclusions. Acute disc prolapse is rare in the elderly and primarily affects the upper lumbar and lower thoracic spine.