An in-press article from The Spine Journal proposes that adolescent lumbar disk herniation patients enjoy a greater level of postoperative satisfaction than adults.
A Swedish research team, led by Tobias Lagerbäck, Department of Orthopaedics, Karolinska Univeristy Hospital, Stockholm, Sweden, used the Swedish Spine Register, a national quality register, to conduct the prospective observational study, with the initial hypothesis that adolescents have a similar outcome of surgery as adults. Lagerbäck and colleagues believes that “This study provides the first prospective results of surgery for lumbar disk herniation in adolescents.”
A total of 10,615 patients were divided into three age groups: adolescents (18 years or younger; n=151), younger adults (19-39 years; n=4,386) and older adults (40 years and older; n=6,078), who were then followed for one to two years after surgery (mean follow-up was 1.8 years). The youngest patient at time of surgery was 12, and the oldest 90.
The primary outcomes were patient satisfaction and global assessment of leg and back pain. Secondary outcomes were visual analogue scale (VAS) leg pain, VAS back pain, Oswestry Disability Index (ODI), and EuroQol 5-Dimensions (EQ-5D). Financial support was given by the Swedish Society of Spine Surgeons. Statistical analyses were performed with the Welch F-test, the Chi-square test, and the Wilcoxon signed rank test.
Preoperatively, VAS for leg and back pain did not differ significantly between the groups, though the team note that adolescents had a significantly longer period of pain before surgery than the adult patients. ODI and EQ-5D scores were higher in the adolescent group (p>0.001 for both comparisons).
All age groups saw a significant improvement following surgery, though patients still did not reach the level of the general quality of life, according to EQ-5D, in the normal population. That said, 86% of the adolescents were satisfied with the outcome of surgery compared to 78% in the younger adults and 76% in the older adults group (p<0.001). According to the global assessment, significantly decreased leg pain was experienced by 87% of the adolescents, 78% of the younger adults and 71% of the older adults (p<0.001). Corresponding figures for back pain were 88%, 73% and 70%, respectively (p<0.001). All groups experienced significant post-operative improvement of VAS leg pain, VAS back pain, ODI and EQ-5D (all p<0.001).
Lagerbäck and colleagues write that their findings are supported by previous studies, such as that conducted by “Lavelle et al, who reported that 90% of adolescents experienced good or excellent outcomes after one year, and that they seemed to have better results that adults.”
“In summary, surgery for lumbar disk herniation among adolescents gives a high rate of satisfaction, which was even higher than in adults,” the authors report. “Future studies should include comparison between conservative treatment and surgery for adolescents and long-term follow-ups. However, surgery for lumbar disk herniation in adolescents, with the same indications as for adults, could be considered as an affective option to conservative treatment.”
Lagerbäck told Spinal News International that “The Swedish Spine Register makes it possible to study rare diagnoses, like lumbar disc herniation in adolescents, and provides prospective data. With its help, we have already started a long-term follow-up of 5 to 10 years. We would like to give a special thanks to all the patients for their invaluable participation in the Swedish Spine Register.”