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Evidence based medicine for surgical trainees

The Spine Patient Outcomes Research Trial (SPORT)

Lumbar discectomy is one of the most common procedures performed, however the efficacy of the procedure relative to non-operative care remains controversial. The Spine Patient Outcomes Research Trial (SPORT) is one of the landmark papers comparing short- and long-term outcomes, with over 500 patients randomised to either surgical or nonsurgical treatment for symptomatic lumbar disc herniation. Patients in both groups demonstrated significant improvements in both primary and secondary outcomes over the first two years with no statistically significant difference between them. Subsequent follow up seems to favour the surgical arm, however the science remains unclear. What is apparent from all studies is that careful selection of the appropriate patient for surgical intervention based on a comprehensive clinical assessment and share decision making is key. See the references below to read the full articles in JAMA and Spine.

Weinstein JN, Tosteson TD, Lurie JD, et al. Surgical versus nonoperative treatment for lumbar disc herniation: The Spine Patient Outcomes Research Trial (SPORT): A randomised trial. JAMA. 2006; 296(20): 2441-2450.




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