Lurie J, Tosteson T, Tosteson A, et al
. Spine. 15 January 2015; 40(2): 63–76.
SPORT is a very large randomized trial with a concurrent observational cohort study that involved 13 spine centers in 11 US states. Part of the study compared the outcomes of surgery (decompressive laminectomy) with non-operative care for symptomatic lumbar spinal stenosis. Primary outcomes were SF-36 Bodily Pain and Physical Function scales and the modified Oswestry Disability Index. This study followed the results of SPORT out to 8 years as prior data showed surgery for spinal stenosis was more effective than non-operative treatment during 4 years. At 8-year follow up, intent-to-treat analyses showed no differences between randomized cohorts. As-treated analyses in the randomized group showed that the early benefit for surgery out to 4 years converged over time, with no significant treatment effect of surgery seen in years 6 to 8 for any of the primary outcomes. In contrast, the observational group showed a stable advantage for surgery in all outcomes between years 5 and 8.
Comment: SPORT is the largest study of its kind to compare surgical vs non-surgical treatment of spine disorders. This study is one of the papers coming out of SPORT that followed the long term outcome to 8 years in patients with lumbar spinal stenosis. The study showed diminishing benefits of surgery in as-treated analyses of the randomized group between 4 and 8 years, whereas outcomes in the observational group remained stable. It is difficult to translate the result of this study towards a significant clinical change. However, it does point out the possibility that surgical treatment for lumbar spinal stenosis may not have the long-term benefit past 4 years.
Icon Credit: The Present Group