SPORT is a multicenter RCT of 501 surgical candidates with imaging-confirmed lumbar disk herniation and ≥6 weeks of radiculopathy, comparing standard open diskectomy to individualized nonoperative care across 13 US spine clinics. It asks whether surgery produces measurably better outcomes than conservative management when analyzed by original treatment assignment. The trial is as important for what it reveals about trial methodology as for its clinical findings.
When a patient with lumbar disk herniation and 6 weeks of radiculopathy asks "will surgery actually help me?", SPORT is the trial you're drawing on. The ITT result — no significant difference. Is the headline most people remember. But that headline is a statistical artifact of crossover, not a clinical truth.
The as-treated data are what inform the consent conversation: surgery provides roughly 15 points of improvement on the ODI and SF-36 scales at 1 year compared to continuing nonoperative care. That is a clinically meaningful difference by any threshold.
When you see a patient who has failed 6 weeks of structured nonoperative treatment with confirmed imaging findings and matching radiculopathy, the SPORT data support offering surgery as a faster, more complete path to relief. Not as the only option, but as a genuinely superior one for patients who want quicker improvement.
The trial also established that patients who delay surgery because symptoms are improving are making a rational choice. Natural history is favorable. But those with worsening symptoms and higher disability at baseline are the ones most likely to ultimately need surgery anyway.
SPORT is a multicenter RCT of 501 surgical candidates with imaging-confirmed lumbar disk herniation and ≥6 weeks of radiculopathy, comparing standard open diskectomy to individualized nonoperative care across 13 US spine clinics. It asks whether surgery produces measurably better outcomes than conservative management when analyzed by original treatment assignment. The trial is as important for what it reveals about trial methodology as for its clinical findings.
When a patient with lumbar disk herniation and 6 weeks of radiculopathy asks "will surgery actually help me?", SPORT is the trial you're drawing on. The ITT result — no significant difference. Is the headline most people remember. But that headline is a statistical artifact of crossover, not a clinical truth.
The as-treated data are what inform the consent conversation: surgery provides roughly 15 points of improvement on the ODI and SF-36 scales at 1 year compared to continuing nonoperative care. That is a clinically meaningful difference by any threshold.
When you see a patient who has failed 6 weeks of structured nonoperative treatment with confirmed imaging findings and matching radiculopathy, the SPORT data support offering surgery as a faster, more complete path to relief. Not as the only option, but as a genuinely superior one for patients who want quicker improvement.
The trial also established that patients who delay surgery because symptoms are improving are making a rational choice. Natural history is favorable. But those with worsening symptoms and higher disability at baseline are the ones most likely to ultimately need surgery anyway.