Surgical Versus Nonoperative Treatment for Lumbar Disc Herniation

• DOI: 10.1097/brs.0b013e31818ed8f4
• Publication Date: 2008-11-24T08:11:22Z
• Authors: James N. Weinstein; Jon D. Lurie; Tor D. Tosteson; Anna N. A. Tosteson; Emily A. Blood; William A. Abdu; Harry Herkowitz; Alan Hilibrand; Todd Albert; Jeffrey Fischgrund
• Keywords: Oswestry Disability Index; Discectomy

In Brief Study Design. Concurrent, prospective, randomized, and observational cohort study. Objective. To assess the 4-year outcomes of surgery versus nonoperative care. Summary Background Data. Although randomized trials have demonstrated small short-term differences in favor surgery, long-term comparing surgical to treatment remain controversial. Methods. Surgical candidates with imaging-confirmed lumbar intervertebral disc herniation meeting SPORT eligibility criteria enrolled into (501 participants), cohorts (743 participants) at 13 spine clinics 11 US states. Interventions were standard open discectomy usual Main outcome measures changes from baseline SF-36 Bodily Pain (BP) Physical Function (PF) scales modified Oswestry Disability Index (ODI - AAOS/Modems version) assessed 6 weeks, 3 months, annually thereafter. Results. Nonadherence assignment caused intent-to-treat analyses underestimate effects. combined as-treated analysis, those receiving significantly greater improvement all primary (mean change vs. nonoperative; effect; 95% CI): BP (45.6 30.7; 15.0; 11.8 18.1), PF (44.6 29.7; 14.9;12.0 17.8) ODI (−38.1 −24.9; −13.2; −15.6 −10.9). The percent working was similar between groups, 84.4% 78.4% respectively. Conclusion. a analysis 4 years, patients who underwent for achieved than nonoperatively treated secondary except work status. Four-year results Spine Patient Outcomes Research Trial (SPORT) are detailed, including discussion crossover comparisons other trials. At had maintained compared remained nonoperative.