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In Reply: Dr Haig is concerned that the nonoperative treatment in SPORT was not standardized and may have therefore been suboptimal. We agree that, as we discussed in our article, the individualized nonoperative treatment protocol does not allow us to comment on the effect of surgery vs any specific nonoperative intervention; nor do we know what the outcomes might have been for a hypothetical optimal nonoperative regimen.

Although the majority of the enrolling physicians were surgeons, most worked in multidisciplinary spine centers. We have examined variations in treatments received by patients in SPORT enrolled by surgeons vs nonoperative physicians and found no differences in treatment approaches or intensity between these 2 groups. In addition, the outcomes of the nonoperative treatments received in SPORT were excellent and were substantially better than prior results reported in the literature.¹

The studies cited by Haig point out the importance of an adequate control group . . . [Full Text of this Article]

Jon D. Lurie, MD, MS; James N. Weinstein, DO, MSc
sport@dartmouth.edu

Tor D. Tosteson, ScD; Anna N. A. Tosteson, ScD
Dartmouth Medical School
Hanover, NH

RELATED LETTER

Nonoperative Treatment for Lumbar Disk Herniation
Andrew J. Haig
JAMA. 2007;297(14):1545.
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