JAMA 22/29 Nov 2006

The Spine Patient Outcomes Research Trial (SPORT) tried to randomise patients with disc herniation and radicular signs to receive either open discectomy or non-operative treatment. But the referee couldn’t keep control, and players kept changing sides and leaving before full time –fun to watch if you like that sort of thing. Patients in the non-operative group kept insisting on surgery, and a lot were lost to follow-up. Drawing any conclusions from this study is like trying to boil an egg that someone has dropped on the floor. For some reason, JAMA decided to publish it, not just in one report but actually two (see here), plus an editorial making sport of the shortcomings of surgical trials.

This study was conducted at the Onze Lieve Vrouwe Gasthuis, Amsterdam. It’s possible that you think a Gasthuis in Amsterdam means a place where teenage boys go to smoke joints and watch dubious films on the television, but they would get a nasty shock at this one, since cardiothoracic surgery is performed on all the guests. Moreover, on arrival they are told to swish their mouths with chlorhexidine gluconate and snort a nasal ointment containing the same. This reduces postoperative infection after cardiac surgery; but many complain that the only trip they get is this well scary room with lots of lights and instruments, and the nurses keep their clothes on.