Extract
Question: In patients with intervertebral disc herniation and
persistent symptoms, is surgery more effective than nonoperative
treatment?Design: Randomized (unclear allocation concealment), unblinded,
controlled trial with 2-year follow-up (Spine Patient Outcomes Research Trial
[SPORT]).Setting: 13 spine practices in 11 U.S. states.Patients: 501 patients who were =18 years of age and had
intervertebral disc herniation and persistent symptoms despite some form of
nonoperative treatment for =6 weeks. Inclusion criteria were radicular pain
and evidence of nerve-root irritation with a positive nerve-root tension sign
or a corresponding neurologic deficit, and candidacy for surgery with evidence
of disc herniation (protrusion, extrusion, or sequestered fragment) on
advanced vertebral imaging. Exclusion criteria included previous lumbar
surgery, cauda equina syndrome, scoliosis >15°, segmental instability,
vertebral fractures, spine infection or tumor, inflammatory
spondyloarthropathy, pregnancy, comorbid conditions contraindicating surgery,
or inability or unwillingness to have surgery within 6 months. 472 patients
(mean age, 42 y; 59% men) had =1 follow-up visit. 1-year follow-up was 83%;
2-year follow-up was 74%.