Interpreting the Spine Patient Outcomes Research Trial. Medical vs surgical treatment of lumbar disk herniation: implications for future trials.

The Spine Patient Outcomes Research Trial (SPORT) consisted of two parallel studies: an observational study and a randomized comparison of medical and surgical treatment of disk herniation. In the long-term, patients did well with either treatment, and an intention-to-treat analysis found no difference in outcomes. However, at 2 years 40% of patients in the surgical group of the randomized study still hadn't had surgery, and 40% of the medical patients did have surgery, muddying the results. Surgery was superior according to an analysis by the treatment patients actually received, but the study has been criticized for methodologic shortcomings, and the topic remains controversial.