Nonsurgical Treatment of Lumbar Disk Herniation: Are Outcomes Different in Older Adults?

Objective of the study: To determine whether older adults (age ≥ 60 years) experience less improvement in disability and pain with nonsurgical treatment of lumbar disk herniation (LDH), as compared to younger adults (age < 60 years).

Design: Prospective longitudinal comparative cohort study.

Setting: Outpatient specialty spine clinic

Participants: 133 consecutive patients with radicular pain and MR-confirmed acute LDH (89 younger adults and 44 older adults).

Intervention: Nonsurgical treatment tailored to the individual patient.

Measurements: Patient-reported disability on the Oswestry Disability Index (ODI), leg pain intensity, and back pain intensity were recorded at baseline, 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, either with or without adjustment for potential confounders. Adjusted mean improvements in older adults as compared to younger adults were 31 vs. 33 (p=0.63) for ODI, 4.5 vs. 4.5 (p=0.99) for leg pain, and 2.4 vs. 2.7 for back pain (p=0.69). 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, as compared to younger adults.

Conclusion: These preliminary findings suggest that the outcomes of LDH with nonsurgical treatment were not worse in older adults (age≥60 years) as compared to younger adults (age<60 years). Future research is warranted to examine nonsurgical treatment for LDH in older adults.


Suri P, Hunter DJ, Jouve C, et al. Nonsurgical treatment of lumbar disk herniation: are outcomes different in older adults?. J Am Geriatr Soc. 2011;59(3):423-429. doi:10.1111/j.1532-5415.2011.03316.x.