Another striking similarity across all of these studies that span 4 decades is the relatively high rate of crossover to surgery for patients who initially chose or were randomized to nonoperative treatment. Weber reported a 26% crossover rate, Osterman et al. 36%, Peul et al. 39%, the MLSS 40%, and SPORT 45%.7-9 These results indicate that it is may not be possible to conduct an effective RCT comparing surgery to nonoperative treatment for lumbar disc herniation. At the same time, these results are not surprising given that patients who fail nonoperative treatment are unlikely to continue ineffective treatment. As would be expected, the SPORT patients who crossed over from nonoperative treatment to surgery had worse baseline symptoms and the perception that their symptoms were becoming worse, whereas those who crossed over from surgery to nonoperative treatment had less severe symptoms that were improving.
所有这些研究跨越40余年，具有另一个惊人的相似之处：患者最初选择或随机分配进行非手术治疗而后变换为手术治疗的比率相对较高。Weber报道有26%的变换率，Osterman等为36%，Peul等为39%，MlSS40%，SPORT高达45%[7-9]。这些结果提示，为了比较腰椎间盘突出症的手术与非手术治疗，要实施一个非常有效的RCT似乎是不太可能的。同时，考虑到这些患者非手术治疗失败后不可能再继续进行无效的治疗，而导致这样的结果也并不令人意外。如SPORT所预期的一样，从非手术治疗变换为手术的患者起初的症状更严重，并且他们认为其症状会变得更糟糕；而从手术治疗变换为非手术治疗的患者，症状严重者较少，并且认为可以得到改善。
Based on the evidence, most spine providers now agree that, on average, diskectomy results in a more rapid and greater degree of improvement, though nonoperative treatment can be successful in a large proportion of patients. Unfortunately, our ability to predict which patients will be successful with nonoperative treatment is quite limited. The next step for researchers is to use the available data to develop predictive models to improve our ability to determine which treatment is the most appropriate for individual patients. These studies should allow a shared decision model where patients can determine their preference for care based on their symptoms, values, and the available evidence.24 Such a tool would allow many patients to avoid unnecessary surgery and others to avoid prolonged periods of ineffective nonoperative treatment. While all the studies reviewed here provide answers for the “average” patient, we now have to work on applying evidence to the treatment of individual patients, none of whom are “average.”
基于以上证据，大多数脊柱外科医生目前都认同，平均来看，椎间盘切除术可以获得更快更大程度的改善，然而非手术治疗则可在一大部分患者中取得成功。遗憾的是，我们预测哪些患者通过非手术治疗可以获得成功的能力非常有限。研究人员接下来就要着手应用现有的数据，开发预测模型，以改善我们的决策能力，决定哪些治疗方法是最适合某些个体的。这些研究应该提供一个共享决策模型，患者可以根据他们的症状、价值取向以及现有的证据决定他们所喜欢的治疗方案[24]。这样一个工具可使很多患者避免不必要的手术，而使另一部分患者避免延长无效的非手术治疗的期限。通过对本文中所有研究的综述，为“一般”患者提供了答案，我们接下来将着手应用证据治疗个体患者，他们中没有谁是“一般”患者。 作者: PT师 时间: 2013-6-18 18:01
请问SPORT和MLSS是什么意思？