Surgery for many lumbar spine conditions remains controversial with disparate opinions on its value and a perceived lack of objective scientific justification. This discussion addresses the value of the information provided by the recent Spine Patient Outcomes Research Trial (SPORT) and the utility of surgery for the enigma of low back pain.
The SPORT Study: Did the National Institutes of Health Get Its $15 Million Worth?
The SPORT Study: Pro
The SPORT study is the largest-ever lumbar spine investigation funded by the U.S. National Institutes of Health (NIH). Its goals were to compare surgical and nonsurgical treatments for patients with lumbar disc herniation, spinal stenosis, or degenerative lumbar spondylolisthesis with spinal stenosis. These three diagnoses represent the vast majority of surgical disorders involving the lumbar spine in the adult population. An innovative study design consisted of concurrent enrollment of the three diagnostic groups into a surgical trial with randomized and observational cohorts with identical enrollment criteria1. In addition, informed choice through the use of pre-enrollment patient decision aids was utilized. All data for this study were gathered electronically and housed at the site of the primary investigator, Dr. James Weinstein, at Dartmouth-Hitchcock Medical Center. The study population consisted of 5580 screened patients, 4246 of whom were eligible to participate. Following review of the shared decision-making video by the eligible patients, 2505 were enrolled. The randomized group consisted of 1094 patients, 542 of whom were assigned to surgical treatment and 552, to nonoperative treatment. The observational group consisted of 1411 patients, 913 of whom were treated surgically and 498 of whom received nonoperative care. This observational group represented the patients who did not wish to be randomized. The study population was gathered from thirteen participating sites representing the East and West Coasts, Midwest, South, and Central Plains. This geography was a representative cross-section of the U.S. population. Outcomes were assessed by the primary measures of the Short …
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