Surgical versus Non-operative Treatment for Lumbar Disc Herniation (SPORT Trial)
- Lumbar discectomy is the most common surgical intervention performed in the United States to treat back and leg symptoms. However, discectomy rates vary widely both regionally within the United States and also internationally.
- Radiologically, lumbar disc herniations can be observed in absence of symptoms, and can regress spontaneously over time.
- Multi-center, randomized, controlled trial.
- Patients with imaging-confirmed lumbar disc herniations, persistent signs/symptoms of radiculopathy for ≥6 weeks, randomly divided into Surgery group and Non-operative group.
- Outcome measures: Primary outcomes were changes from baseline for SF-36 bodily pain and physical function scales, and the modified Oswestry Disability Index at 6 weeks, 3 months, 6 months, 1 year and 2 years. Secondary outcomes were sciatica severity, satisfaction with symptoms, self-reported improvement, and employment status.
- Surgery group: 232 patients, of whom 50% underwent standard open discectomy within 3 months, however, 39.7% did not undergo surgery.
- Non-operative group: 240 patients, received physical therapy, education and NSAIDs. However, 30% of patients in this group underwent surgery within 3 months, and 44.6% in total ended up having surgery.
- Outcomes: Intent-to-treat analyses showed significant improvement in all primary and secondary outcomes for both groups. Between-group analyses favored surgical intervention for all time periods but were small and not statistically significant for the primary outcomes.
- Limitations: Due to the significant percentage of patient crossover in both directions, the study was unable to draw conclusions about the superiority or equivalence of the treatments.