SPORT is a 13-center trial enrolling 607 patients with lumbar degenerative spondylolisthesis and spinal stenosis into parallel randomized (n=304) and observational (n=303) cohorts. It asks whether the functional advantages of surgery over nonoperative care — established at two years — persist through four years. Primary outcomes were SF-36 bodily pain, physical function, and Oswestry Disability Index measured serially to four years.
The Maine Lumbar Spine Study had raised a legitimate concern: surgical benefit for spinal stenosis appeared to erode over time. SPORT's four-year data answers that concern directly for degenerative spondylolisthesis specifically — and the answer is reassuring.
When counseling a patient with degenerative spondylolisthesis and spinal stenosis who has failed 12 weeks of conservative care, you can cite specific, durable numbers: surgery produces roughly 15 to 19 SF-36 points of improvement and 14 ODI points of improvement over nonoperative care, sustained without decay through at least four years.
The subgroup data matters clinically. Neurogenic claudication predicts a larger surgical benefit (bodily pain effect 18.4 vs. 10.4 for radicular symptoms alone), so patients presenting with positional leg fatigue and bilateral lower extremity symptoms are your best surgical candidates.
The 54% crossover rate from conservative to surgical management is itself a clinical data point. It reflects what happens in real practice when patients with this condition are managed conservatively and fail. Most eventually choose surgery, and those who do after failing conservative care still benefit.
SPORT is a 13-center trial enrolling 607 patients with lumbar degenerative spondylolisthesis and spinal stenosis into parallel randomized (n=304) and observational (n=303) cohorts. It asks whether the functional advantages of surgery over nonoperative care — established at two years — persist through four years. Primary outcomes were SF-36 bodily pain, physical function, and Oswestry Disability Index measured serially to four years.
The Maine Lumbar Spine Study had raised a legitimate concern: surgical benefit for spinal stenosis appeared to erode over time. SPORT's four-year data answers that concern directly for degenerative spondylolisthesis specifically — and the answer is reassuring.
When counseling a patient with degenerative spondylolisthesis and spinal stenosis who has failed 12 weeks of conservative care, you can cite specific, durable numbers: surgery produces roughly 15 to 19 SF-36 points of improvement and 14 ODI points of improvement over nonoperative care, sustained without decay through at least four years.
The subgroup data matters clinically. Neurogenic claudication predicts a larger surgical benefit (bodily pain effect 18.4 vs. 10.4 for radicular symptoms alone), so patients presenting with positional leg fatigue and bilateral lower extremity symptoms are your best surgical candidates.
The 54% crossover rate from conservative to surgical management is itself a clinical data point. It reflects what happens in real practice when patients with this condition are managed conservatively and fail. Most eventually choose surgery, and those who do after failing conservative care still benefit.