Impact of age on neurological recovery and clinical outcomes after lumbar microdiscectomy: a prospective 2-year follow-up study

OBJECTIVE The efficacy and safety of lumbar microdiscectomy in older compared with younger patients remain subjects of ongoing debate. The aim of this study was to compare postoperative pain relief, functional improvement, and the speed and extent of motor and sensory recovery between patients younger and older than 70 years over a 2-year follow-up period. METHODS Data were prospectively collected from patients undergoing lumbar microdiscectomy for symptomatic disc herniation at a single institution between 2016 and 2025. Patients were stratified into two age groups: < 70 years and ≥ 70 years. Preoperative symptom duration, defined as the period of continuous clinical symptoms leading to the current surgical indication, was prospectively recorded and compared between age groups. Clinical outcomes were assessed using the numeric rating scale for low back pain and radicular leg pain, Oswestry Disability Index as an indicator of functional improvement, and neurological examinations at 6 weeks, 6 months, 12 months, and 24 months postoperatively. RESULTS Of 1220 patients (656 male, median age 47.0 years) included in this analysis, 1037 were aged < 70 years and 83 were aged ≥ 70 years. Both age groups had comparable reductions in low back pain and radicular leg pain, as well as functional improvement throughout the 24-month follow-up. However, significant age-related differences in neurological recovery were observed. Younger patients (age < 70 years) demonstrated significantly faster and more complete recovery of both motor and sensory deficits at all follow-up intervals starting from 6 weeks. At 24 months, residual motor deficits were significantly more prevalent in the older (≥ 70 years) age group, as were residual sensory deficits. CONCLUSIONS While chronological age should not be a contraindication to lumbar microdiscectomy, as excellent pain relief and functional improvement were achieved in both age groups, older patients (≥ 70 years) should be counseled regarding a lower probability of full neurological recovery. These findings emphasize the need for individualized expectations in the aging population, but do not rule out the good effect of microdiscectomy in older patients with lumbar disc herniation.