title: Commentary on: The role of surgery for treatment of low back pain: Insights from the randomized controlled SPORT trials.
abstract: BACKGROUND
  The SPORT trial database offered much useful information regarding the efficacy of surgical treatment for lumbar disc herniations, lumbar spinal stenosis, and degenerative spondylolisthesis. Data were obtained from 13 sites and included 2500 patients.
  
  
  METHODS
  The randomized trial for lumbar disc herniations was contaminated by the immense crossover of patients from surgical (50%) to non-surgical (30%) groups. Weinsteinet al. concluded that they could not claim superiority of one treatment modality over the other. Weinstein's next SPORT study on lumbar discs, performed utilizing a prospective cohort of patients undergoing lumbar disc surgery (those that would not agree to be randomized), appeared to demonstrate better outcomes with vs. without surgery.
  
  
  RESULTS
  The follow-up study 8 years later again questioned the value of surgery vs. non-operative intervention. The other SPORT studies dealing with degenerative spondylolisthesis appeared to document the benefit of surgical decompression, but could not consistently substantiate the relative value of decompression alone vs. non-instrumented vs. instrumented fusion. The more recent SPORT study in 2015 on spinal stenosis treated with/without surgery indicated improvement in short term 4-year outcomes; however, the two arm-results (surgical vs. non-surgical) converged at 8 years.
  
  
  CONCLUSIONS
  Here, the 6 SPORT studies and short commentaries following each study indicate the pros, cons, and shortcomings of each investigation are presented. Notably, if surgeons better selected patients for surgery and avoided unnecessary procedures for "black discs alone" or pain alone, the results of the surgical intervention would likely be more clearly confirmed.
authors.affiliation: Department of Neuroscience, Winthrop Neuroscience, Winthrop University Hospital, Mineola, New York, USA.
authors.forename: Nancy E
authors.initials: NE
authors.lastname: Epstein
keywords: Degenerative lumbar disease; SPORT trial; lumbar disc; spondylolisthesis