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SURGICAL VERSUS NON SURGICAL THERAPY



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The n e w e ng l a n d j o u r na l of m e dic i n e original article Surgical versus Nonsurgical Therapy for Lumbar Spinal Stenosis James N Weinstein D O M S Tor D Tosteson Sc D Jon D Lurie M D M S Anna N A Tosteson Sc D Emily Blood M S Brett Hanscom M S Harry Herkowitz M D Frank Cammisa M D Todd Albert M D Scott D Boden M D Alan Hilibrand M D Harley Goldberg D O Sigurd Berven M D and Howard An M D for the SPORT Investigators A bs t r ac t Background From the Departments of Orthopedics J N W E B B H Community and Fam ily Medicine T D T J D L A N A T and Medicine J D L A N A T Dartmouth Medical School Hanover NH and Dart mouth Hitchcock Medical Center Leba non NH William H Beaumont Hospital Royal Oak MI H H Hospital for Spe cial Surgery New York F C Rothman Institute at Thomas Jefferson University Philadelphia T A A H Emory Spine Cen ter Emory University Atlanta S D B Kaiser Permanente San Francisco H G University of California at San Francisco San Francisco S B and Rush Presbyte rian St Luke s Medical Center Chicago H A Address reprint requests to Dr Weinstein at the Dartmouth Institute for Health Policy and Clinical Practice Depart ment of Orthopedics Dartmouth Medical School 1 Med ical Center Dr Lebanon NH 03756 or at sport dartmouth edu Investigators in the Spine Patient Out comes Research Trial SPORT are listed in the Appendix N Engl J Med 2008 358 794 810 Copyright 2008 Massachusetts Medical Society Surgery for spinal stenosis is widely performed but its effectiveness as compared with nonsurgical treatment has not been shown in controlled trials Methods Surgical candidates with a history of at least 12 weeks of symptoms and spinal stenosis without spondylolisthesis as confirmed on imaging were enrolled in either a randomized cohort or an observational cohort at 13 U S spine clinics Treatment was decompressive surgery or usual nonsurgical care The primary outcomes were measures of bodily pain and physical function on the Medical Outcomes Study 36 item Short



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