Evidence brief
Surgical vs Nonoperative Treatment for Lumbar Disk Herniation: The Spine Patient Outcomes Research Trial (SPORT)
High crossover rate (50%) limited intent-to-treat analysis
As-treated analysis showed surgery superior at 2 years
Surgery provides faster pain relief
By 4-8 years, outcomes converge for many patients
Surgery preferred for severe/progressive neurological deficit
SPORT demonstrated that both surgical and non-operative treatment are reasonable for lumbar disc herniation. Surgery provides faster relief but long-term outcomes may be similar. Patient preference is important.
Know SPORT findings but also its limitations (high crossover diluted ITT analysis). Key point: surgery gives faster relief, but long-term outcomes may converge. Absolute indications for surgery: cauda equina, progressive neurological deficit.
Level I
Systematic review of RCTs or high-quality RCT