Two articles in this issue of JAMA report results of the Spine Patient Outcomes Research Trial (SPORT), a randomized trial that evaluated the efficacy of standard open diskectomy vs nonoperative (“usual care”) treatment for lumbar disk herniation. In the first article, Weinstein and colleaguesArticle report that intent-to-treat analyses demonstrated small but not statistically significant improvements in pain and function that favored diskectomy during the 2-year follow-up period. However, since large numbers of patients crossed over from their assigned treatment to the alternate treatment, the authors could not reach definitive conclusions regarding treatment superiority or equivalence. In the second article, the authorsArticle report results for patients who refused random assignment to operative or nonoperative treatment and were enrolled in a parallel observational cohort study. Among these patients, those who chose surgery reported greater improvement in pain and function compared with patients who chose nonoperative care. In an editorial, FlumArticle discusses the interpretation of trials with subjective outcomes and the potential value of sham-controlled surgical trials. In a second editorial, CarrageeArticle discusses lumbar disk herniation and factors that influence patients' treatment preference.