Elsevier

Surgical Neurology

Volume 58, Issues 3–4, September–October 2002, Pages 209-212
Surgical Neurology

Lumbar disc herniation: level increases with age

https://doi.org/10.1016/S0090-3019(02)00797-8Get rights and content

Abstract

BACKGROUND

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.

METHODS

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.

RESULTS

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).

CONCLUSION

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.

Section snippets

Patients and methods

Clinical data from 2838 patients suffering from lumbar back and sciatic pain were obtained from the neurologic database of Atrium Medical Center, Heerlen. Data from a time-span of 4 years (1995–1998) were collected retrospectively. Lumbar disc herniation was found in 1431 patients (50.4%). Mean age ± SEM was calculated. In turn, this was correlated to the level at which the disc herniation was localized. Either computed tomography (CT), magnetic resonance imaging (MRI), or both confirmed

Results

The distribution of lumbar disc herniation in our patient group is 40.9% at L5-S1, 38.0% at L4–5, 19.1% at L3–4, and 2.0% at L2–3.

The mean age for each level of herniation is given Table 1. The mean (± SEM) age at the different levels is 44.1 ± 0.5 years for at the L5-S1 level, 49.5 ± 0.6 for the L4–5 level, 59.5 ± 0.9 for the L3–4 level, and 59.6 ± 2.7 for the L2–3 level. The mean age of patients with lumbar disc herniation at levels L4–5, L3–4, and L2–3 is significantly higher than the mean

Discussion

Since the description of sciatica by Cotugno (1764) and the observations by Dandy, Mixter, and Barr in the late 1920s and early 1930s, a lot of knowledge has been accumulated of the epidemiology, symptomatology, and pathogenesis of herniated lumbar discs 3, 5. We know that lumbar disc disease is uncommon in the first two decades of life and peaks in the fourth decade. It occurs in men more often than in women. The two lower levels (L4–5 and L5-S1) are responsible for over 95% (50% and 46%,

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