Lumbar disc herniation: level increases with age

Prompted by the clinical impression that L4 radicular syndrome and disc herniations at L3-4 occurred at older ages we studied the correlation between age and level of herniated discs.

We retrospectively correlated mean age and level of disc herniation of patients suffering from lumbar disc herniation. Data from 1431 patients were obtained from the neurologic database of the Atrium Medical Center Heerlen from 1995 through 1998. Nonparametric data were analyzed with the Mann-Whitney U test, and correlation was analyzed using linear regression.

Mean ages of the patients with disc herniation at L5-S1, L4-5, L3-4, and L2-3 were 44.1 +/- 0.5 years, 49.5 +/- 0.6 years, 59.5 +/- 0.9 years, and 59.6 +/- 2.7 years, respectively. Mean ages were significantly higher with herniation levels at L4-5, L3-4, and L2-3 compared to L5-S1 (p < 0.0001). Analogously, the mean age of patients with disc herniation at L3-4 was significantly higher compared to those with herniation at L4-5 (p < 0.0001). No difference in mean age was seen between L3-4 and L2-3 (p = 0.815). A strong correlation was observed between the level of herniation and increasing age (R = 0.371; p < 0.0001).

These results indeed prove that with increasing age, lumbar disc herniation is more cranially localized. It may help in understanding the patho-anatomic process of disc herniation, and in recognizing higher level radicular syndromes in advanced age.