ORIGINAL CONTRIBUTION Surgical vs Nonoperative Treatment for Lumbar Disk Herniation

LUMBAR DISKECTOMY IS THE MOSTcommon surgical procedureperformed in the United Statesfor patients having back and leg symptoms; the vast majority of the pro-cedures are elective. However, lumbar disk herniation is often seen on imag-ing studies in the absence of symp-toms1,2 and can regress over time with-out surgery.3 Up to 15-fold variation in regional diskectomy rates in the United States4 and lower rates internationally raise questions regarding the appropri-ateness of some of these surgeries.5,6 Several studies have compared sur-gical and nonoperative treatment of pa-tients with herniated disk, but base-line differences between treatment groups, small sample sizes, or lack of validated outcome measures in these studies limit evidence-based conclu-sions regarding optimal treatment.7-12 The Spine Patient Outcomes Research Trial (SPORT) was initiated in March 2000 to compare the outcomes of sur-gical and nonoperative treatment for lumbar intervertebral disk herniation, spinal stenosis, or degenerative spondy-lolisthesis.13 The trial included both a randomized cohort and an observa-tional cohort who declined to be ran