New Sports Medicine Research
SPORT trial:
Randomized SPORT trial: Surgical vs. non-operative treatment for lumbar disk herniation: The SPORT trial, a randomized trial, JAMA, 296(20):2441-2450
The SPORT trial is a series of two large multi-center trials studying radicular low back pain, commonly referred to as “sciatica.” In one trial, patients with radicular low back pain were randomly assigned to either surgery or non-operative management and followed over the course of two years to monitor their pain and function. In a second trial, patients themselves chose whether to have surgery or non-operative management and again, the patients were monitored for two years to monitor their pain and function.
This is considered a landmark study because it is the only study of its size comparing the surgical management of radicular low back pain to non-operative management. Some important conclusions emerged from the SPORT trial. First, one of the main motivations in the past for operative management of radicular low back pain in the past has been concern that without operative management, the patient may be at risk for progressive neurological compromise. In the SPORT trial, however, the rate of progressive neurological complications was no higher for the non-operatively managed groups than for the surgical managed groups. Second, for the randomly assigned patients, no statistically significant differences emerged between the non-operative and surgical groups. Finally, amongst patients who chose whether or not to have surgery, the patients who chose surgery tended to have worse initial baseline demographics and accordingly, had greater improvements from what was a worse baseline.
The interpretation of this important study has been hotly debated amongst clinicians. While the SPORT trial was well designed, there are some limitations that limit its interpretation. However, the SPORT trial is an important new piece of evidence further demonstrating that the non-operative management of radicular low back pain is a reasonable option for those patients who wish to avoid surgery.
Gary Chimes, MD, PhD
2006-2007 RIC Keiser Friedmann Sports & Spine Fellow