Gerrit J Bouma,1 Ardeshir Ardeshiri,2 Larry E Miller,3 Erik Van de Kelft,4,5 Richard Bostelmann,6 Peter D Klassen,7 Charlotte Flüh,8 Adisa Kuršumović91Department of Neurosurgery, OLVG and Amsterdam University Medical Centers, Amsterdam, the Netherlands; 2Section for Spine Surgery, Klinikum Itzehoe, Itzehoe, Germany; 3Miller Scientific Consulting, Asheville, NC, USA; 4Department of Neurosurgery, AZ Nikolaas, Sint-Niklaas, Belgium; 5Antwerp University, Antwerp, Belgium; 6Department of Neurosurgery, University Clinic Düsseldorf, Duesseldorf, Germany; 7Department of Neurosurgery, St. Bonifatius Hospital, Lingen, Germany; 8Department of Neurosurgery, University Medical Center Schleswig-Holstein, Kiel, Germany; 9Department of Neurosurgery, Donauisar Klinikum Deggendorf, Deggendorf, GermanyBackground: Lumbar discectomy is a common surgical procedure in middle-aged adults. However, outcomes of lumbar discectomy among older adults are unclear.Methods: Lumbar discectomy patients with an annular defect ≥6 mm width were randomized to receive additional implantation with a bone-anchored annular closure device (ACD, n=272) or no additional implantation (controls, n=278). Over 3 years follow-up, main outcomes were symptomatic reherniation, reoperation, and the percentage of patients who achieved the minimum clinically important difference (MCID) without a reoperation for leg pain, Oswestry Disability Index (ODI), SF-36 Physical Component Summary (PCS) score, and SF-36 Mental Component Summary (MCS) score. Results were compared between older (≥60 years) and younger (