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Spine Patient Outcomes Research Trial: Do Outcomes Vary Across Centers for Surgery for Lumbar Disc Herniation?

Desai, Atman MD*; Bekelis, Kimon MD*; Ball, Perry A. MD*; Lurie, Jon MD; Mirza, Sohail K. MD§; Tosteson, Tor D. DSc; Zhao, Wenyan MS§; Weinstein, James N. DO, MS§,¶

doi: 10.1227/NEU.0b013e31826772cb
Research-Human-Clinical Studies: Editor's Choice
Editor's Choice
CNS University of Neurosurgery

BACKGROUND: Lumbar discectomy is the most commonly performed spine procedure. Academic spine centers with potentially differing caseloads and experience may have different outcomes.

OBJECTIVE: To determine whether the choice of center in which surgery is performed affects lumbar discectomy outcomes.

METHODS: Spine Patient Outcomes Research Trial participants with a confirmed diagnosis of intervertebral disc herniation undergoing standard first-time open discectomy were followed from baseline at 6 weeks, and 3, 6, and 12 months, and yearly thereafter, at 13 spine clinics in 11 US states. Patient data from this prospective study were reviewed. Enrollment began in March 2000 and ended in November 2004.

RESULTS: Seven hundred ninety-two patients underwent first-time lumbar discectomy. Significant differences were found among centers in patient age and race, baseline levels of disability, and treatment preferences. There were no significant differences among the centers in other patient characteristics (eg, sex, body mass index, the prevalence of smoking, diabetes, or hypertension), or disease characteristics (herniation level or type). Some short-term outcomes varied significantly among centers, including operative duration and blood loss, the incidence of durotomy, the length of hospital stay, and reoperation rate. However, there were no differences among the centers in incidence of nerve root injury, postoperative mortality, Short Form 36 scores of body pain or physical function, or Oswestry Disability Index at 4 years.

CONCLUSION: Although mean blood loss, risk of durotomy, length of stay, and rate of reoperation vary among academic spine centers performing lumbar discectomy, there appears to be no difference in long-term functional outcomes.

ABBREVIATIONS: AUC, area under the curve

IDH, intervertebral disc herniation

SBI, Sciatica Bothersomeness Index

SF-36, Short Form 36

SPORT, Spine Patient Outcomes Research Trial

*Section of Neurosurgery, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire

Department of Medicine, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire

§Department of Orthopaedics, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire

The Dartmouth Institute for Health Policy and Clinical Practice, Hanover, New Hampshire

Correspondence: Atman Desai, MD, Dartmouth-Hitchcock Medical Center, Section of Neurosurgery, One Medical Center Dr, Lebanon, NH 03756. E-mail:

Received August 16, 2011

Accepted June 20, 2012

Copyright © by the Congress of Neurological Surgeons