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Commentary on: The role of surgery for treatment of low back pain: Insights from the randomized controlled SPORT trials

BACKGROUND: The SPORT trial database offered much useful information regarding the efficacy of surgical treatment for lumbar disc herniations, lumbar spinal stenosis, and degenerative spondylolisthesis. Data were obtained from 13 sites and included 2500 patients. METHODS: The randomized trial for lu...

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Autor principal: Epstein, Nancy E.
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Medknow Publications & Media Pvt Ltd 2016
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5054639/
https://www.ncbi.nlm.nih.gov/pubmed/27843678
http://dx.doi.org/10.4103/2152-7806.191069
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author Epstein, Nancy E.
author_facet Epstein, Nancy E.
author_sort Epstein, Nancy E.
collection PubMed
description BACKGROUND: The SPORT trial database offered much useful information regarding the efficacy of surgical treatment for lumbar disc herniations, lumbar spinal stenosis, and degenerative spondylolisthesis. Data were obtained from 13 sites and included 2500 patients. METHODS: The randomized trial for lumbar disc herniations was contaminated by the immense crossover of patients from surgical (50%) to non-surgical (30%) groups. Weinstein et al. concluded that they could not claim superiority of one treatment modality over the other. Weinstein's next SPORT study on lumbar discs, performed utilizing a prospective cohort of patients undergoing lumbar disc surgery (those that would not agree to be randomized), appeared to demonstrate better outcomes with vs. without surgery. RESULTS: The follow-up study 8 years later again questioned the value of surgery vs. non-operative intervention. The other SPORT studies dealing with degenerative spondylolisthesis appeared to document the benefit of surgical decompression, but could not consistently substantiate the relative value of decompression alone vs. non-instrumented vs. instrumented fusion. The more recent SPORT study in 2015 on spinal stenosis treated with/without surgery indicated improvement in short term 4-year outcomes; however, the two arm-results (surgical vs. non-surgical) converged at 8 years. CONCLUSIONS: Here, the 6 SPORT studies and short commentaries following each study indicate the pros, cons, and shortcomings of each investigation are presented. Notably, if surgeons better selected patients for surgery and avoided unnecessary procedures for “black discs alone” or pain alone, the results of the surgical intervention would likely be more clearly confirmed.
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spelling pubmed-50546392016-11-14 Commentary on: The role of surgery for treatment of low back pain: Insights from the randomized controlled SPORT trials Epstein, Nancy E. Surg Neurol Int Surgical Neurology International: Spine BACKGROUND: The SPORT trial database offered much useful information regarding the efficacy of surgical treatment for lumbar disc herniations, lumbar spinal stenosis, and degenerative spondylolisthesis. Data were obtained from 13 sites and included 2500 patients. METHODS: The randomized trial for lumbar disc herniations was contaminated by the immense crossover of patients from surgical (50%) to non-surgical (30%) groups. Weinstein et al. concluded that they could not claim superiority of one treatment modality over the other. Weinstein's next SPORT study on lumbar discs, performed utilizing a prospective cohort of patients undergoing lumbar disc surgery (those that would not agree to be randomized), appeared to demonstrate better outcomes with vs. without surgery. RESULTS: The follow-up study 8 years later again questioned the value of surgery vs. non-operative intervention. The other SPORT studies dealing with degenerative spondylolisthesis appeared to document the benefit of surgical decompression, but could not consistently substantiate the relative value of decompression alone vs. non-instrumented vs. instrumented fusion. The more recent SPORT study in 2015 on spinal stenosis treated with/without surgery indicated improvement in short term 4-year outcomes; however, the two arm-results (surgical vs. non-surgical) converged at 8 years. CONCLUSIONS: Here, the 6 SPORT studies and short commentaries following each study indicate the pros, cons, and shortcomings of each investigation are presented. Notably, if surgeons better selected patients for surgery and avoided unnecessary procedures for “black discs alone” or pain alone, the results of the surgical intervention would likely be more clearly confirmed. Medknow Publications & Media Pvt Ltd 2016-09-22 /pmc/articles/PMC5054639/ /pubmed/27843678 http://dx.doi.org/10.4103/2152-7806.191069 Text en Copyright: © 2016 Surgical Neurology International http://creativecommons.org/licenses/by-nc-sa/3.0 This is an open access article distributed under the terms of the Creative Commons Attribution-NonCommercial-ShareAlike 3.0 License, which allows others to remix, tweak, and build upon the work non-commercially, as long as the author is credited and the new creations are licensed under the identical terms.
spellingShingle Surgical Neurology International: Spine
Epstein, Nancy E.
Commentary on: The role of surgery for treatment of low back pain: Insights from the randomized controlled SPORT trials
title Commentary on: The role of surgery for treatment of low back pain: Insights from the randomized controlled SPORT trials
title_full Commentary on: The role of surgery for treatment of low back pain: Insights from the randomized controlled SPORT trials
title_fullStr Commentary on: The role of surgery for treatment of low back pain: Insights from the randomized controlled SPORT trials
title_full_unstemmed Commentary on: The role of surgery for treatment of low back pain: Insights from the randomized controlled SPORT trials
title_short Commentary on: The role of surgery for treatment of low back pain: Insights from the randomized controlled SPORT trials
title_sort commentary on: the role of surgery for treatment of low back pain: insights from the randomized controlled sport trials
topic Surgical Neurology International: Spine
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5054639/
https://www.ncbi.nlm.nih.gov/pubmed/27843678
http://dx.doi.org/10.4103/2152-7806.191069
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