The SPORT trial compared surgery versus nonsurgical care for degenerative spondylolisthesis with spinal stenosis in 607 patients across 13 U.S. centers. Both a randomized and an observational cohort were enrolled with identical selection criteria and outcomes. The study asks whether surgery provides meaningful benefit over usual care at 2 years.
When a patient with image-confirmed degenerative spondylolisthesis and persistent neurogenic claudication asks whether surgery is worth it, SPORT gives you the numbers: an 18-point gain in pain and function over 2 years compared to nonsurgical care, with benefit apparent within 6 weeks.
The catch is the trial's design flaw: 40% of randomized patients crossed over in each direction, making the RCT's intention-to-treat result meaningless. The conclusion rests on as-treated analysis — which is subject to confounding but was carefully adjusted and consistent across both cohorts.
For practice: nonsurgical care is not futile. SPORT patients managed without surgery did improve moderately, and none developed cauda equina syndrome. This supports a trial of structured nonsurgical care in patients who are not severely disabled, while recognizing that surgery offers substantially greater and faster relief.
Know the complication profile: 10% dural tear rate and 12% 2-year reoperation rate are the numbers to quote when counseling patients on surgical risk.
The SPORT trial compared surgery versus nonsurgical care for degenerative spondylolisthesis with spinal stenosis in 607 patients across 13 U.S. centers. Both a randomized and an observational cohort were enrolled with identical selection criteria and outcomes. The study asks whether surgery provides meaningful benefit over usual care at 2 years.
When a patient with image-confirmed degenerative spondylolisthesis and persistent neurogenic claudication asks whether surgery is worth it, SPORT gives you the numbers: an 18-point gain in pain and function over 2 years compared to nonsurgical care, with benefit apparent within 6 weeks.
The catch is the trial's design flaw: 40% of randomized patients crossed over in each direction, making the RCT's intention-to-treat result meaningless. The conclusion rests on as-treated analysis — which is subject to confounding but was carefully adjusted and consistent across both cohorts.
For practice: nonsurgical care is not futile. SPORT patients managed without surgery did improve moderately, and none developed cauda equina syndrome. This supports a trial of structured nonsurgical care in patients who are not severely disabled, while recognizing that surgery offers substantially greater and faster relief.
Know the complication profile: 10% dural tear rate and 12% 2-year reoperation rate are the numbers to quote when counseling patients on surgical risk.