New SPORT Data Favors Surgery for the Treatment of Spondylolisthesis with Stenosis
BY LAUREN UZDIENSKI, JUNE 2, 2009
JBJS published data from the ongoing SPORT trial in this month's edition of the journal, and, like prior results from the study, patients who undergo spine surgery fare better than patients who don't.
This arm of the analysis focused on patients with degenerative spondylolisthesis associated with spinal stenosis and included data at four years, building on previous two-year data that showed positive improvements in pain and function in surgical cases compared to non-surgical treatments. There were two cohorts: 304 patients in a randomized cohort, where 66% of those randomized for surgery received it by four years. It should be noted that 54% of those randomized for non-surgical care also received surgery at four years. In the 303-patient observational cohort, 97% of those who chose surgery received it whereas 33% of those who chose nonoperative care eventually received surgery.
In this study, "surgery" refers to a decompressive laminectomy (with or without fusion). Non-surgical care is not explicitly defined, but it is understood to include everything from physical therapy to steroid injections to NSAIDS.
When the cohorts were evaluated based on intent-to-treat (i.e, how the patients were randomized), surgical and non-surgical care resulted in similar outcomes. However, when looking at the data from an as-treated perspective (what the patients actually did, regardless of how they were randomized), surgery had an edge: patients report a 15.3-point improvement in bodily pain, an 18.9-point improvement for physical function and a decrease of 14.3 points on the ODI scale. This indicates that gains reported in earlier two-year results were maintained at four years. Among secondary measures, patient reports of back and leg symptoms, overall satisfaction with current symptoms and progress were also maintained at four years.
More data should be forthcoming from the five-year SPORT trial, which is evaluating surgical outcomes for patients diagnosed with disc herniation, stenosis and spondylolisthesis. At 2,500 enrolled patients across 13 sites in the U.S., the study is the largest of its kind.
