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.

Agency
National Institute of Health (NIH)
Institute
National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS)
Type
Research Project--Cooperative Agreements (U01)
Project #
5U01AR045444-14
Application #
8272465
Study Section
Special Emphasis Panel (ZAR1-CHW-G (M2))
Program Officer
Chen, Faye H
Project Start
1999-07-04
Project End
2014-05-31
Budget Start
2012-06-01
Budget End
2013-05-31
Support Year
14
Fiscal Year
2012
Total Cost
$612,166
Indirect Cost
$277,478
Name
Dartmouth College
Department
Public Health & Prev Medicine
Type
Schools of Medicine
DUNS #
041027822
City
Hanover
State
NH
Country
United States
Zip Code
03755
Weinstein, James N; Tosteson, Anna N A; Tosteson, Tor D et al. (2014) The SPORT value compass: do the extra costs of undergoing spine surgery produce better health benefits? Med Care 52:1055-63
Lurie, Jon D; Tosteson, Tor D; Tosteson, Anna N A et al. (2014) Surgical versus nonoperative treatment for lumbar disc herniation: eight-year results for the spine patient outcomes research trial. Spine (Phila Pa 1976) 39:3-16
McGuire, Kevin J; Khaleel, Mohammed A; Rihn, Jeffrey A et al. (2014) The effect of high obesity on outcomes of treatment for lumbar spinal conditions: subgroup analysis of the spine patient outcomes research trial. Spine (Phila Pa 1976) 39:1975-80
Dickinson, Lawrence D; Phelps, Jeffery; Summa, Christopher D et al. (2013) Facet-sparing decompression with a minimally invasive flexible microblade shaver: a prospective operative analysis. J Spinal Disord Tech 26:427-36
(2013) Point of View: Interspinous Spacers versus Decompressive Surgery for Lumbar Neurogenic Intermittent Claudication. Spine (Phila Pa 1976) :
Kang, Kevin K; Shen, Michael S; Zhao, Wenyan et al. (2013) Retrolisthesis and lumbar disc herniation: a postoperative assessment of patient function. Spine J 13:367-72
Pearson, Adam M; Lurie, Jon D; Tosteson, Tor D et al. (2013) Who should undergo surgery for degenerative spondylolisthesis? Treatment effect predictors in SPORT. Spine (Phila Pa 1976) 38:1799-811
Radcliff, Kristen; Freedman, Mitchell; Hilibrand, Alan et al. (2013) Does opioid pain medication use affect the outcome of patients with lumbar disc herniation? Spine (Phila Pa 1976) 38:E849-60
Desai, Atman; Bekelis, Kimon; Ball, Perry A et al. (2013) Variation in outcomes across centers after surgery for lumbar stenosis and degenerative spondylolisthesis in the spine patient outcomes research trial. Spine (Phila Pa 1976) 38:678-91
Radcliff, Kris; Curry, Patrick; Hilibrand, Alan et al. (2013) Risk for adjacent segment and same segment reoperation after surgery for lumbar stenosis: a subgroup analysis of the Spine Patient Outcomes Research Trial (SPORT). Spine (Phila Pa 1976) 38:531-9

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