The other day in clinic a patient asked me about the “SPORT” study they had read about in the paper. I explained the research trial to the patient and in turn they stated that most patients would want to know this information. On this month’s blog we will discuss this important study.
The Spine Patient Outcomes Research Trial (SPORT) was a multicenter, NIH funded randomized trial comparing surgical vs non-surgical treatments in regards to 3 conditions:
- lumbar disc herniations
- degenerative listheses
- lumbar stenosis.
Outcomes reviewed included use of narcotics, function level and return to work. Overall, patients treated surgically tended to do better than non surgical patients up to 4 years from treatment.
These findings are important to patients and doctor’s because the government and insurance companies are increasingly demanding high quality data to support treatment options- surgery vs non-surgery. Most patients undergo conservative management (physical therapy, epidural injections, medications and activity modification) for non emergent conditions because the majority of the time people get better. However, if these non surgical options fail…surgery?
The 3 conditions looked at including lumbar disc herniations (piece of the disc has torn/ broken and is causing nerve irritation), listhesis (abnormal translation of 1 spine bone in relation to another) and stenosis (pinched nerves) are common conditions. The results from the SPORT study support better long term relief from surgery for each of these 3 conditions. These findings are helpful because as a physician I can recommend a surgery and have a study to support the decision apart from my personal experience and training. For example, the common thinking among spine surgeons is whether or not you get surgery for a disc herniation; at 1 year your results are the same. This study shows that at 4 years, surgery patients have better quality of life than non-surgery patients.
Ultimately, patient selection is still critical. Not everyone is a surgical candidate and conservative options do help. However, if you find yourself with one of these conditions (disc herniation, stenosis, listhesis) and non-surgery options have not helped…..surgery may be your best option.
Paul Saiz, MD