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Surgery proves better than nonoperative care in early SPORT results

Disc surgery patients had better symptom relief and function at one year compared to nonop patients.

Issue: Issue 4 2006

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BERGEN, Norway — Initial results from a U.S. National Institutes of Health trial showed that of 501 patients with herniated lumbar discs, those treated operatively fared better than nonoperatively treated patients. Those results came from the randomized, controlled portion of this study.

James N. Weinstein, DO, MS, of Dartmouth-Hitchcock Medical Center, Lebanon, U.S.A., presented the results of patients with lumbar disc herniation at the International Society for the Study of the Lumbar Spine (ISSLS) 33rd Annual Meeting.

“In every case, the surgical group tended to do better in the primary outcomes and the secondary measures,” Weinstein said.

Those included were treated by 142 physicians at 13 sites in 11 states, making it a nationally representative sample of patients evaluated for back and leg pain symptoms diagnosed with disc herniation, he said.

Surgery group improves

By the one-year follow-up, all patients with symptoms of herniated discs enrolled in the Spine Patient Outcomes Research Trial (SPORT) demonstrated substantial improvement in outcomes measures such as bodily pain, physical function, disability and sciatica.

Those treated surgically “showed a statistically significant advantage for surgical over nonoperative treatment for the Oswestry Disability Index (ODI), sciatica, satisfaction with symptoms, and self-rated improvement,” according to the abstract.

Patient eligibility

To be enrolled, patients had to be at least 18 years old with symptoms that lasted for a minimum of six weeks. For the surgical intervention, investigators used open discectomy but could individualize the nonoperative treatment.

“It is not surprising to me that the surgery patients in this study did so well,” David W. Polly Jr., MD, said in a press release. “Even with the inherent biases toward nonoperative care, the early statistics show what a great therapy option surgery is,” said Polly, chief of spinal surgery at the University of Minnesota, Minneapolis.

The SPORT study also included an observational cohort of 743 patients with disc herniations, 95% of who opted to undergo surgery but did not want to be randomized. At baseline, they were fairly similar to those in the randomized group.

Weinstein said three years of data were available for the observational group. After two years of follow-up, their primary outcomes remained significant and their results were similar to the randomized controlled patients’ as-treated results, he said.

The study was selected as the best paper from the ISSLS meeting. Additional SPORT results are expected to be presented at the North American Spine Society’s 21st Annual Meeting in September.

For more information:

• Weinstein JN, Lurie JD, Tosteson TD, et al. Surgical vs. non-operative treatment for lumbar disc herniation: RCT and observational cohort outcomes from SPORT (Spine Patient Outcomes Research Trial). #3. Presented at the International Society for the Study of the Lumbar Spine 33rd Annual Meeting. June 14-17, 2006. Bergen, Norway.