SPORT enrolled 654 surgical candidates with imaging-confirmed lumbar spinal stenosis (without spondylolisthesis) and at least 12 weeks of symptoms across 13 U.S. spine clinics. Using both a randomized cohort (n=289) and a concurrent observational cohort (n=365), it compared standard posterior decompressive laminectomy against usual nonsurgical care. Primary outcomes were SF-36 Bodily Pain, Physical Function, and Oswestry Disability Index measured over 2 years.
A 2005 Cochrane review found prior stenosis trials too small and heterogeneous to draw conclusions — no controlled trial had ever studied isolated stenosis without spondylolisthesis. SPORT filled that gap, and its answer is clear: when you have a patient with neurogenic claudication, imaging-confirmed stenosis, and symptoms persisting beyond 12 weeks despite conservative care, surgery produces meaningfully greater improvement in pain and function than continued nonsurgical management.
When interpreting SPORT, always default to the as-treated results. The 43% crossover rate in the nonsurgical arm (the sickest patients, with strongest surgical preference, who couldn't wait) made the intention-to-treat analysis uninterpretable for most outcomes. And the as-treated estimates were concordant across both cohorts, strengthening their validity.
Nonsurgical stenosis patients barely improved over 2 years (Oswestry improved only 9.3 points), unlike disc herniation patients who often recover substantially without surgery. This is why earlier surgical consideration is appropriate in symptomatic stenosis candidates who have failed conservative care. The natural history does not reliably bail you out.
SPORT enrolled 654 surgical candidates with imaging-confirmed lumbar spinal stenosis (without spondylolisthesis) and at least 12 weeks of symptoms across 13 U.S. spine clinics. Using both a randomized cohort (n=289) and a concurrent observational cohort (n=365), it compared standard posterior decompressive laminectomy against usual nonsurgical care. Primary outcomes were SF-36 Bodily Pain, Physical Function, and Oswestry Disability Index measured over 2 years.
A 2005 Cochrane review found prior stenosis trials too small and heterogeneous to draw conclusions — no controlled trial had ever studied isolated stenosis without spondylolisthesis. SPORT filled that gap, and its answer is clear: when you have a patient with neurogenic claudication, imaging-confirmed stenosis, and symptoms persisting beyond 12 weeks despite conservative care, surgery produces meaningfully greater improvement in pain and function than continued nonsurgical management.
When interpreting SPORT, always default to the as-treated results. The 43% crossover rate in the nonsurgical arm (the sickest patients, with strongest surgical preference, who couldn't wait) made the intention-to-treat analysis uninterpretable for most outcomes. And the as-treated estimates were concordant across both cohorts, strengthening their validity.
Nonsurgical stenosis patients barely improved over 2 years (Oswestry improved only 9.3 points), unlike disc herniation patients who often recover substantially without surgery. This is why earlier surgical consideration is appropriate in symptomatic stenosis candidates who have failed conservative care. The natural history does not reliably bail you out.