Best Practice Case Studies-Surgical vs Nonoperative Treatment for Lumbar Disk Herniation

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The Spine Patient Outcomes Research Trial (SPORT) aimed to compare surgical and nonoperative treatments for lumbar disk herniation. Conducted from March 2000 to November 2004 across 13 multidisciplinary spine clinics in the U.S., the study included 501 participants who experienced persistent radiculopathy for at least six weeks and had confirmed herniated disks. Participants were randomized to receive either standard open diskectomy or nonoperative care tailored to the individual.<br /><br />The primary outcomes were measured through changes in the Medical Outcomes Study 36-item Short-Form Health Survey (SF-36) scores for bodily pain and physical function, and the Oswestry Disability Index (ODI) over various intervals up to two years. Secondary outcomes included sciatica severity, symptom satisfaction, self-reported improvement, and employment status.<br /><br />Findings showed substantial improvements in both the surgical and nonoperative groups over the two years. Although patients undergoing surgery showed consistently greater improvements in primary outcomes, the differences were small and not statistically significant. Notably, significant improvements in sciatica severity were associated with surgery.<br /><br />The study encountered significant adherence challenges: 50% of patients assigned to surgery received it within three months, while 30% of those originally assigned to nonoperative care also received surgery. This high crossover suggests the intent-to-treat analysis might underestimate the actual benefit of surgical intervention.<br /><br />Conclusions indicate that while both treatment methods lead to significant improvements, the advantages of surgery in terms of sciatica relief were clear. The substantial crossover rates complicate definitive conclusions about the superiority of either approach based solely on intent-to-treat analyses, underscoring the necessity of considering patient preferences and individual circumstances in treatment decisions.

Meta Tag

Edition 3rd Edition

Related Case 3rd Edition, CASE 55

Topic Spine

Keywords

3rd Edition, CASE 55

3rd Edition

Spine

lumbar disk herniation

surgical treatment

nonoperative treatment

SPORT trial

radiculopathy

diskectomy

SF-36 scores

Oswestry Disability Index

sciatica severity

treatment outcomes