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Nonoperative Treatment for Lumbar Disk Herniation
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To the Editor: In the Spine Patient Outcomes Research Trial (SPORT) observational cohort study, Dr Weinstein and colleagues1 reported that most patients with disk herniation had improvement in the measures of bodily pain and physical function, but the results for patients who received surgical treatment for disk herniation were considered marginally better than for those who received nonsurgical treatment. The physicians participating in SPORT were primarily surgeons, and it is concerning that the nonsurgical approaches used in the control population were not standardized.
A subanalysis of outcomes for patients treated by surgeons vs those treated by physiatrists would be interesting, but would not dismiss this concern. After SPORT was designed, a series of articles demonstrated the importance of credible rehabilitation in a control population. One randomized trial found lumbar fusion superior to unspecified "conservative treatment."2 However, 2 subsequent studies with a very basic rehabilitation program showed no surgical benefit.3-4
Financial . . . [Full Text of this Article]
Andrew J. Haig, MD
andyhaig@umich.edu
Department of Physical Medicine and Rehabilitation
University of Michigan
Ann Arbor
RELATED LETTER
Nonoperative Treatment for Lumbar Disk Herniation—Reply
Jon D. Lurie, James N. Weinstein, Tor D. Tosteson, and Anna N. A. Tosteson
JAMA. 2007;297(14):1545.
EXTRACT
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RELATED ARTICLE
Surgical vs Nonoperative Treatment for Lumbar Disk Herniation: The Spine Patient Outcomes Research Trial (SPORT) Observational Cohort
James N. Weinstein, Jon D. Lurie, Tor D. Tosteson, Jonathan S. Skinner, Brett Hanscom, Anna N. A. Tosteson, Harry Herkowitz, Jeffrey Fischgrund, Frank P. Cammisa, Todd Albert, and Richard A. Deyo
JAMA. 2006;296(20):2451-2459.
ABSTRACT
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