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Acute disc herniation in the elderly
Melissa C Werndle1, Abbas Reza, Ken Wong
1Academic Neurosurgery Unit, St George's, University of London, Cranmer Terrace, London, UK.
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.
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