Results of SPORT Study Reported Inaccurately
You may have heard in the news recently results from the federally-funded SPORT study. SPORT stands for Spine Patient Outcomes Research Trial. This seven-year long study of 1244 patients cost 13.5 million dollars.
News reports suggested a startling conclusion about treatment for back pain from lumbar disc herniation as a result of the SPORT study. Many reports summarized the findings by saying that patients got the same results with or without surgery for disc problems.
You may have heard that patients in the surgery group got better faster but the long-term results were the same between the operative and nonoperative groups. You heard right but the interpretation of the results is inaccurate.
In this critical review, Dr. McCormick from the Department of Neurosurgery at Columbia University in New York reports on the SPORT study from top to bottom. He offers explanations for the study results.
The study was set up with a randomized design. This means that patients were put into the operative or nonoperative group randomly (without a specific order or pattern). They weren't put in one group or another based on their symptoms or personal preference. But they were allowed to crossover.
Crossover means that if they were in one group, they could switch to the other group. In the end what happened was that some patients with severe pain and other distressing symptoms who were in the nonoperative group decided to have surgery. And patients in the surgery group with mild to moderate pain opted to avoid surgery and have conservative care instead.
But the final results for each patient were still reported under the original group they were placed in. So the results for nonoperative cases who actually had surgery were still placed on the nonoperative side and vise versa. Results for patients in the surgical group who didn't end up having surgery were still linked with surgery.
The study did confirm that patients are able to decide what's best for them. And patient choice tends to be: surgery for severe, constant pain and conservative care for patients with less pain and less disability.
Paul C. McCormick, MD, MPH. The Spine Patient Outcomes Research Trial Results for Lumbar Disc Herniation: A Critical Review. In Journal of Neurosurgery:Spine. June 2007. Vol. 6. No. 6. Pp. 513-520.