TY  - JOUR
T1  - Surgical vs nonoperative treatment for lumbar disk herniation: The spine patient outcomes research trial (sport): a randomized trial
AU  - Weinstein JN, Tosteson TD, Lurie JD, et al
Y1  - 2006/11/22
N1  - 10.1001/jama.296.20.2441
JO  - JAMA
SP  - 2441
EP  - 2450
VL  - 296
IS  - 20
N2  - Context 
                  Lumbar diskectomy is the most common surgical procedure performed for back and leg symptoms in US patients, but the efficacy of the procedure relative to nonoperative care remains controversial.Objective 
                  To assess the efficacy of surgery for lumbar intervertebral disk herniation.Design, Setting, and Patients 
                  The Spine Patient Outcomes Research Trial, a randomized clinical trial enrolling patients between March 2000 and November 2004 from 13 multidisciplinary spine clinics in 11 US states. Patients were 501 surgical candidates (mean age, 42 years; 42% women) with imaging-confirmed lumbar intervertebral disk herniation and persistent signs and symptoms of radiculopathy for at least 6 weeks.Interventions 
                  Standard open diskectomy vs nonoperative treatment individualized to the patient.Main Outcome Measures 
                  Primary outcomes were changes from baseline for the Medical Outcomes Study 36-item Short-Form Health Survey bodily pain and physical function scales and the modified Oswestry Disability Index (American Academy of Orthopaedic Surgeons MODEMS version) at 6 weeks, 3 months, 6 months, and 1 and 2 years from enrollment. Secondary outcomes included sciatica severity as measured by the Sciatica Bothersomeness Index, satisfaction with symptoms, self-reported improvement, and employment status.Results 
                  Adherence to assigned treatment was limited: 50% of patients assigned to surgery received surgery within 3 months of enrollment, while 30% of those assigned to nonoperative treatment received surgery in the same period. Intent-to-treat analyses demonstrated substantial improvements for all primary and secondary outcomes in both treatment groups. Between-group differences in improvements were consistently in favor of surgery for all periods but were small and not statistically significant for the primary outcomes.Conclusions 
                  Patients in both the surgery and the nonoperative treatment groups improved substantially over a 2-year period. Because of the large numbers of patients who crossed over in both directions, conclusions about the superiority or equivalence of the treatments are not warranted based on the intent-to-treat analysis.Trial Registration 
                  clinicaltrials.gov Identifier: NCT00000410
SN  - 0098-7484
M3  - doi: 10.1001/jama.296.20.2441
UR  - http://dx.doi.org/10.1001/jama.296.20.2441
ER  -