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Trial Questions Benefits of Herniated Disc Surgery

SPORT trial shows limited benefit of surgery compared with non-operative treatment

TUESDAY, Nov. 21 (HealthDay News) -- The benefits of surgery compared with non-operative treatment for lumbar disc herniation appear to be limited, or at least inconclusive, according to two reports in the Nov. 22/29 issue of the Journal of the American Medical Association.

James Weinstein, D.O., M.Sc., of Dartmouth Medical School in Hanover, N.H., and the Spine Patient Outcomes Research Trial (SPORT) investigators found that 472 patients with lumbar disc herniation randomized to either surgical or non-operative treatment had similar improvements in clinical outcome after two years. Adherence to treatment was limited and slight improvements from surgery were found to be statistically insignificant.

In a second observational study of SPORT that included 743 patients initially refusing randomization, surgery showed improvement in bodily pain, physical function and disability index at three months compared with usual care. The differences narrowed after two years, however, and the authors caution against interpretation of non-randomized self-reported outcomes.

"These findings suggest that in most cases there is no clear reason to advocate strongly for surgery apart from patient preference," writes Eugene Carragee, M.D., of Stanford University Medical Center in Stanford, Calif., in an accompanying editorial. "For the patient with emotional, family and economic resources to handle mild or moderate sciatica, surgery may have little to offer."

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