• STUDY DESIGN: A retrospective cohort analysis of the Treatment effects considering factors of disc size,  Modic Changes,  Nerve compression,  etc.

Data from the Spine Outcomes Research Trial  (SPORT) was used to form a retrospective cohort analysis regarding the treatment effects of nonsurgical and surgical patients with lumbar herniated discs.

Baseline comparisons of patients who had complete and incomplete MRI studies were reviewed and there was no difference between the populations.

Statistical analysis was based on 307 patients who had complete imaging studies.

The study concluded that surgical treatment for lumbar disc herniations occupying greater than one third of the canal space, had greater  positive surgical treatment effects than those patients with smaller disc herniations.  In addition, patients with type I Modic had decreased improvements in ODI scores post surgical management compared to Patients without Modic changes.

These observations are consistent with generally reviewed clinical outcomes.  Larger disc herniations treated surgically have better outcomes.  Inflammatory Modic changes are associated with back pain that do not improve with surgical management.

The criticism of the study is secondary to it being a retrospective cohort analysis.  Data was reviewed from the SPORT study.  Authors acknowledge shortcomings, and reflect on the small sample size for some subsets.

Considering the retrospective cohort nature of the study,  it had a Good Spineopedia Score.