A Landmark Study of Surgical versus Non-surgical Treatment for Spine Conditions
Dartmouth-Hickock Medical Center and The New England Journal of Medicine recently reported results that found that surgery for three prevalent spine conditions works better than all other non-surgical treatments. The study details the findings of the Spine Patient Outcomes Research Trial (SPORT), a 7-year, $21 million, study of 13 spine centers, funded by the National Institutes of Health. It collected data on 654 patients experiencing radicular pain for at least 12 weeks.
The report is a first — an “evidence-based” study in which researchers did statistical analysis of how spinal patients fared with surgery versus non-surgical treatment. Surgery involved relieving pressure on the nerves. There are very strict criteria for enrolling a patient in a research trial. Before a trial is started, it and its methods must be approved by the sponsoring organization—in this case the National Institutes of Health—and by an Internal Review Board (IRB), made up of health care professionals and others not affiliated with the trial itself. Finally, a data safety monitoring board oversees the trial, constantly reviewing the results and information being gathered. This board can step in and stop a trial at any time if it appears the treatment isn’t helping the patients involved.
In the study the positive treatment effect for surgery was seen as early as 6 weeks, appeared to reach a maximum at 6 months, and persisted for 2 years. It is notable that the condition of patients in the non-surgical group improved only moderately during the 2-year period.
The first results were from the Intervertebral Disc Herniation trial. The study found that while both groups improved substantially after treatment, the improvement from spine surgery, through a procedure called a “discectomy”, was more rapid. Patients who had surgery also reported better results in physical function and satisfaction one and two years after the operation.
The second results are from the trial for Degenerative Spondylolisthesis. The study found that patients with spinal stenosis accompanied by Degenerative Spondylolisthesis who were treated surgically showed substantially greater improvement in pain and function through 2 years follow-up compared to patients treated non-surgically.
The third results are from the trial for Spinal Stenosis. The study found that patients with Spinal Stenosis who were treated surgically showed significantly greater improvement in pain, function and disability through 2 years follow-up compared to patients treated non-surgically. Analyses of the 4-year follow-up data for each of the three cohorts, Intervertebral Disc Herniation, Spinal Stenosis, and Degenerative Spondylolisthesis, demonstrated that the gains the surgical patients had made were maintained at four years.
The study noted that, “Patients with spinal problems who underwent surgery showed significantly greater improvement in pain, function, satisfaction, and self-rated progress than did patients who were treated non-surgically”.
Sources: SPORT is funded in part by The National Institute of Arthritis and Musculoskeletal and Skin Diseases (U01-AR45444-01A1) and the Office of Research on Women’s Health, the National Institutes of Health, and the National Institute of Occupational Safety and Health, the Centers for Disease Control and Prevention. The Multidisciplinary Clinical Research Center in Musculoskeletal Diseases is funded by NIAMS S