Surgery Better for Herniated Lumbar Discs

The study enrolled 501 participants with lumbar intervertebral disc herniation, and 743 observational cohorts at 13 spine clinics in 11 US states. Interventions involved standard open discectomy or nonsurgical treatment, such as physical therapy, exercise, and pain-relieving medications. The main outcome measures were changes from baseline in the SF-36 Bodily Pain and Physical Function scales and the modified Oswestry Disability Index (ODI).

The results showed that when outcomes were compared for patients who actually underwent surgery, pain scores averaged about 11 points lower in the surgery group. Measures of physical functioning and disability showed similar differences. Surgery also led to greater improvement in outcomes such as sciatica symptoms, patient satisfaction, and self-rated improvement. But while average outcome scores were better with surgery, many patients did have significant improvement with nonsurgical treatment, especially the one-third of patients who were slated for surgery but chose not to have operative treatment. The study was published in the January 1, 2014, issue of Spine.

“Surgery was superior to non-operative treatment in relieving symptoms and improving function; peak benefits are achieved within six months after surgery, and persist through eight years,” concluded lead author Jon Lurie, MD, MS, and colleagues. “However, many patients treated without surgery also showed substantial improvements over time. Patients who crossed over to surgery were more likely to be dissatisfied with their symptoms, felt like their symptoms were getting worse, and had initially worse physical function and disability.”

“Every patient in the SPORT study went through shared decision-making, during which they reviewed objective information about the risks and benefits of their treatment options. This allowed them to make an informed choice, in line with their own values,” commented SPORT principal investigator James Weinstein, MD. “That about a third of these patients have continued to be satisfied with their choice is in large part due, I believe, to their being active participants in the initial decision-making process.”

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