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Evidence-Based Orthopaedics   |    
Either Surgery or Nonoperative Treatment Led to Improvement in Intervertebral Disc Herniation

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Source of funding: National Institute of Arthritis and Musculoskeletal and Skin Diseases; Office of Research on Women's Health; National Institute for Occupational Safety and Health.
For correspondence: Dr. J.N. Weinstein, Department of Orthopaedics, Dartmouth Medical School, One Medical Center Drive, Lebanon, NH 03756. E-mail address: james.n.weinstein@dartmouth.edu
Weinstein JN, Tosteson TD, Lurie JD, Tosteson ANA, Hanscom B, Skinner JS, Abdu WA, Hilibrand AS, Boden SD, Deyo RA. Surgical vs Nonoperative Treatment for Lumbar Disk Herniation: The Spine Patient Outcomes Research Trial (SPORT): A Randomized Trial.
JAMA
. 2006Nov22;296: 2441-50.

The Journal of Bone and Joint Surgery, Incorporated
J Bone Joint Surg Am, 2007 May 01;89(5):1139-1139. doi: 10.2106/JBJS.8905.ebo3
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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%.
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    These activities have been planned and implemented in accordance with the Essential Areas and policies of the Accreditation Council for Continuing Medical Education (ACCME) through the joint sponsorship of the American Academy of Orthopaedic Surgeons and The Journal of Bone and Joint Surgery, Inc. The American Academy of Orthopaedic Surgeons is accredited by the ACCME to provide continuing medical education for physicians.
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