Carefully selected patients who underwent surgery for a lumbar disc herniation had greater improvements in pain, functioning and disability than did patients who were treated nonoperatively, but the latter group also fared relatively well, a recent analysis showed.


Researchers analyzed follow-up data from 1,244 participants in the Spine Patient Outcomes Research Trial (SPORT). All were surgical candidates with imaging-confirmed lumbar intervertebral disc herniation.


The 501 randomized participants and observational cohorts (743 persons) had been treated at 13 U.S. spine clinics with standard open discectomy or usual nonoperative care, the latter of which was recommended to include, at least, active physical therapy, education/counseling with home-exercise instruction and nonsteroidal anti-inflammatory drugs if tolerated.

The study subjects had been allowed to cross over to the treatment not originally assigned.


Mean scores of post-treatment pain were approximately 11 points lower in the people who had undergone surgery compared with those who had not. Measures of physical functioning and disability were similarly better for the surgery patients.


Many of the nonsurgical patients, however, experienced significant improvements following therapy. After eight years, approximately one-third of the participants who were clinically indicated for surgery had chosen not to have the operation; 54% of the nonsurgical group reported being satisfied with their symptoms and 73% were satisfied with their care eight years later. 


References

  1. Lurie JD et al. Spine. 2014; 39(1):3-16. doi:10.1097/BRS.000000000000008.