Low back related pain is a highly prevalent and costly health problem of major significance to national health policy. Estimated costs of disability from low back pain range from $30-70 billion annually. Rates of spinal surgery in the U.S. have increased sharply overtime, and 12-fold geographic variation in rates of these surgeries has been documented. However, little evidence documents the efficacy and cost-effectiveness of surgical therapy versus non-operative management. The broad objective of the Spine Patient Outcomes Research Trial (SPORT) has been to improve clinical decision making for surgical treatment of low back pain problems. SPORT represents the largest clinical investigation yet conducted of the three most common, disabling and costly low back disorders - intervertebral disc herniation (IDH), spinal stenosis (SpS), and degenerative spondylolisthesis (DS). SPORT'S three multi-center randomized controlled trials (RCTs) and associated observational cohorts compare quality of life outcomes for surgical vs. non-operative treatment. In addition to learning that surgery is an effective treatment for these 3 diagnoses, SPORT confirmed that many patients receiving non-operative treatment also do well, highlighting the importance of informed choice. Among the 2505 patients enrolled in SPORT, 91 have died and 1807 (75%) are actively in follow-up. SPORT III will continue to follow patients and gather long-term functional health, quality of life, and cost- effectiveness data.
Our specific aims are: 1) To continue annual follow-up of all subjects for a minimum of 9 years;2) To compare outcomes of surgical vs. non-operative treatment for low back pain as measured by the SF-36 health status questionnaire and the Oswestry Disability Index;3) To determine long-term cost effectiveness as measured by societal health state values obtained via EuroQoL EQ-5D, and by subject- reported resource utilization and work productivity data. SPORT represents the largest and most diverse spine cohort established to date and constitutes a unique resource with extensive longitudinal data, a well-established clinical trial infrastructure, and high rates of follow-up. Extending the follow-up in these patients through a minimum of 9 years will provide important insights into the long-term outcomes and cost-effectiveness of treatment options in these common, debilitating and expensive conditions. As part of our ongoing efforts at dissemination, we will continue to develop web-based data resources and interactive software for patients, health care providers, and health policy makers seeking to translate the scientific results from SPORT into improved clinical practice.

Public Health Relevance

Initial results from the Spine Patient Outcomes Research Trial (SPORT) found that for patients diagnosed with herniated disc, stenosis or degenerative spondylolisthesis, surgery resulted in better outcomes;however, non-operatively treated patients also did well highlighting the need for informed choice. Long-term follow-up in these unique cohorts is crucial to assess long-term outcomes and cost-effectiveness.

National Institute of Health (NIH)
National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS)
Research Project--Cooperative Agreements (U01)
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Special Emphasis Panel (ZAR1-CHW-G (M2))
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Chen, Faye H
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Dartmouth College
Public Health & Prev Medicine
Schools of Medicine
United States
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Horst, Patrick K; Khanna, Krishn; Racine, Linda et al. (2016) Sex Life and Impact of Operative Intervention on Sex Life-related Pain in Degenerative Spinal Conditions: An Analysis of the SPORT Study. Spine (Phila Pa 1976) 41:1764-1771
Suri, Pradeep; Pearson, Adam M; Scherer, Emily A et al. (2016) Recurrence of Pain After Usual Nonoperative Care for Symptomatic Lumbar Disk Herniation: Analysis of Data From the Spine Patient Outcomes Research Trial. PM R 8:405-14
Gerling, Michael C; Leven, Dante; Passias, Peter G et al. (2016) Risk Factors for Reoperation in Patients Treated Surgically for Lumbar Stenosis: A Subanalysis of the 8-year Data From the SPORT Trial. Spine (Phila Pa 1976) 41:901-9
Suri, Pradeep; Pearson, Adam M; Zhao, Wenyan et al. (2016) Pain Recurrence after Discectomy for Symptomatic Lumbar Disc Herniation. Spine (Phila Pa 1976) :
Lurie, Jon D; Henderson, Eric R; McDonough, Christine M et al. (2016) Effect of Expectations on Treatment Outcome for Lumbar Intervertebral Disc Herniation. Spine (Phila Pa 1976) 41:803-9
Lurie, Jon D; Tosteson, Tor D; Tosteson, Anna et al. (2015) Long-term outcomes of lumbar spinal stenosis: eight-year results of the Spine Patient Outcomes Research Trial (SPORT). Spine (Phila Pa 1976) 40:63-76
Desai, Atman; Ball, Perry A; Bekelis, Kimon et al. (2015) SPORT: Does incidental durotomy affect longterm outcomes in cases of spinal stenosis? Neurosurgery 76 Suppl 1:S57-63; discussion S63
Rihn, Jeffrey A; Hilibrand, Alan S; Zhao, Wenyan et al. (2015) Effectiveness of surgery for lumbar stenosis and degenerative spondylolisthesis in the octogenarian population: analysis of the Spine Patient Outcomes Research Trial (SPORT) data. J Bone Joint Surg Am 97:177-85
Lurie, Jon D (2015) Point of view. Spine (Phila Pa 1976) 40:86
Leven, Dante; Passias, Peter G; Errico, Thomas J et al. (2015) Risk Factors for Reoperation in Patients Treated Surgically for Intervertebral Disc Herniation: A Subanalysis of Eight-Year SPORT Data. J Bone Joint Surg Am 97:1316-25

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