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Spinal StenosisPhase 4NCT00000411

Spine Patient Outcomes Research Trial (SPORT): Spinal Stenosis

A Phase 4 study testing Decompressive laminectomy and Non-surgical treatments in people with Spinal Stenosis and Low Back Pain, run by Dartmouth-Hitchcock Medical Center at 13 sites in United States.

Completed

Finished. The study has ended and is not enrolling. Results may be posted on the official record.

Official record
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Trial summary

This study tests the effectiveness of different treatments for the three most commonly diagnosed conditions of the lower backbone (lumbar spine). The purpose is to learn which of two commonly prescribed treatments (surgery and nonsurgical therapy) works better for specific types of low back pain. Read more about this study

Who is it for?
Ages 18 years and older
Conditions the study is for
Spinal Stenosis, Low Back Pain
What is being tested?
Decompressive laminectomy and Non-surgical treatments
Type of treatment
Surgery or procedure
Could I receive a placebo?
No, everyone receives an active treatment
How many people
289 participants
Where
13 sitesUnited States
Study dates
Mar 2000to Apr 2015
Phase
Phase 4
Are there results?
None posted in the registry

Key requirements

Who can take part, as listed by the sponsor. Only the study team can confirm whether you are eligible, so take this list to your doctor.

  • Ages 18 years and older
  • All sexes
  • No healthy volunteers
  • Adult, Older adult

Who may be able to join

  • Duration of Symptoms: 12 or more weeks.
  • Treatments tried: Nonsteroidal anti-inflammatory medical therapy and physical therapy.
  • Surgical Screening: Pain in low back, buttocks, or lower extremity that becomes worse with lumbar extension. Must be confirmed by evidence of central or central-lateral compression of the cauda equina by a degenerative lesion of the facet joint, disc, or ligamentum flavum on MRI, computed tomography scans, or myelograms.
  • Tests: MRI to confirm diagnosis and level(s).

Who cannot join

  • Previous lumbar spine surgery.
  • Not a surgical candidate for any of these reasons: Overall health that makes spinal surgery too life-threatening to be an appropriate alternative, patient has improved dramatically with conservative care, or the patient is unable (for any reason) to undergo surgery within 6 months.
  • Possible pregnancy.
  • Active malignancy: Patients with a history of any invasive malignancy (except nonmelanoma skin cancer) are ineligible unless they have been treated with curative intent AND have not had any clinical signs or symptoms of the malignancy for at least 5 years.
  • Current fracture, infection, and/or deformity (greater than 15 degrees of lumbar scoliosis, using Cobb measure technique) of the spine.
  • Age less than 18 years.
Show all 10Show fewer
  • Cauda equina syndrome or progressive neurologic deficit (usually requiring urgent surgery).
  • Unavailability for followup (planning to move, no telephone, etc.) or inability to complete data surveys.
  • Symptoms less than 12 weeks.
  • Patient currently enrolled in any experimental "spine related" study.

Trial locations and contacts

13 sites in 1 country.

13 sites in 1 country

United States13 sites
  • Rush-Presbyterian, St. Luke's Medical Center

    Chicago, Illinois, 60612-3833

  • Case Western Reserve University

    Cleveland, Ohio, 44106

  • Emory University, The Emory Clinic

    Decatur, Georgia, 30033

  • Dartmouth-Hitchcock Medical Center - Spine Center

    Lebanon, New Hampshire, 03756

  • New York University, The Hospital for Joint Diseases

    New York, New York, 10003

  • Hospital for Special Surgery

    New York, New York, 10021

  • Kaiser Permanente Spine Care Program

    Oakland, California, 94612

  • Nebraska Foundation for Spinal Research

    Omaha, Nebraska, 68154-4438

  • Rothman Institute at Thomas Jefferson University

    Philadelphia, Pennsylvania, 19107-4216

  • William Beaumont Hospital

    Royal Oak, Michigan, 48073-9952

  • University of California, San Francisco (UCSF)

    San Francisco, California, 94143-0728

  • Maine Spine & Rehabilitation

    Scarborough, Maine, 04074

  • Washington University

    St Louis, Missouri, 63110

Other trials in United States

About this study

Official title: Spine Patient Outcomes Research Trial (SPORT): A Multicenter Trial for Spinal Stenosis (SpS)

This study tests the effectiveness of different treatments for the three most commonly diagnosed conditions of the lower backbone (lumbar spine). The purpose is to learn which of two commonly prescribed treatments (surgery and nonsurgical therapy) works better for specific types of low back pain. Low back pain is one of the most widely experienced health problems in the United States and the world. It is the second most frequent condition, after the common cold, for which people see a doctor or lose days from work.

In this part of the study, we will treat patients with spinal stenosis (a narrowing of spaces in the backbone that results in pressure on the spinal cord and/or nerve roots) with a type of surgery known as posterior decompressive laminectomy or with nonsurgical methods. This study does not cover the cost of treatment.

Read the detailed description

Low back pain is considered one of the most widely experienced health problems in the U.S. and the world. It is the second most frequent condition, after the common cold, for which patients see a physician or lose days from work. Estimated costs to those who are severely disabled from low back pain range from $30-70 billion annually. Rates of spinal surgery in the U.S. have increased sharply over time, and researchers have documented 15-fold geographic variation in rates of these surgeries. In many cases, where one lives and who one sees for the condition appear to determine the rates of surgery. Despite these trends, there is little evidence proving the effectiveness of these therapies over non-surgical management.

This study will use the National Spine Network to conduct a multicenter, randomized, controlled trial for the three most common diagnostic groups for which spine surgery is performed: lumbar intervertebral disc herniation (IDH), spinal stenosis (SpS), and spinal stenosis secondary to degenerative spondylolisthesis (DS). This arm of the trial will deal with patients from the second diagnostic group. The study will compare the most commonly used standard surgical treatments to the most commonly used standard nonsurgical treatments. We will conduct the study at 12 sites throughout the United States.

The primary endpoint of the study will be changes in health-related quality of life as measured by the SF-36 health status questionnaire. Secondary endpoints will include patient satisfaction with treatment, utility for current health in order to estimate quality-adjusted life years (QALYS) as the measure for cost-effectiveness, resource use, and cost.

We will follow patients at 6 weeks and 3, 6, 12, and 24 months to determine their health status, function, satisfaction, and health care use. We anticipate that we will enroll and randomly allocate a total of 370 study participants in this arm of the trial. We will track an additional observational cohort to assess health and resource outcomes. Enrollment in the Observational cohort has been completed as of February 2003.

We will integrate data from the trial and observational cohorts to formally estimate the cost-effectiveness of surgical versus nonsurgical interventions for IDH, SpS, and DS. The results of this trial will provide, for the first time, scientific evidence as to the relative effectiveness of surgical versus nonsurgical treatment for these three most commonly diagnosed lumbar spine conditions.

Being tested
Decompressive laminectomy, Non-surgical treatments
Keywords
Spinal stenosis (SpS), Intervertebral disc herniation (IDH), Degenerative spondylolisthesis (DS), Low back pain (LBP), Surgical therapy, Nonsurgical therapy, Randomized study, Multicenter, MRI
Medical subject headings
Spinal Stenosis, Low Back Pain, Intervertebral Disc Displacement

What participants receive

What participants receive. In a randomised study each person is assigned to one group by chance.

  • Decompressive laminectomyProcedure or surgery

    Removal of the hypertrophic inferior and superior articular facets will be performed when they are intruding upon the midline and causing both central and lateral recess stenosis.

  • Non-surgical treatmentsOther

    Active physical therapy modality, Education/Counseling with home exercise instruction, and an NSAID if tolerated

Study groups in NCT00000411
Study groupRoleWhat they receive
SurgeryActive comparatorDecompressive laminectomy
Receives: Procedure: Decompressive laminectomy; Other: Non-surgical treatments
Non-surgical treatmentsActive comparatorActive physical therapy modality, Education/Counseling with home exercise instruction, and an NSAID if tolerated
Receives: Other: Non-surgical treatments

What is being measured

The primary outcome is the main question the study is designed to answer.

  1. Changes in health-related quality of life as measured by the SF-36 health status questionnaire

    Measured: Baseline, 6 wks, 3 and 6 mos, Annually thereafter

Secondary outcomes (4)
  1. Patient satisfaction with treatment

    Measured: Baseline, 6 wks, 3 mos, Annually thereafter

  2. utility for current health in order to estimate quality-adjusted life years (QALYS) as the measure for cost effectiveness

    Measured: Baseline, 1 yr, 4 yr

  3. resource utilization

    Measured: Baseline, 6 wks, 3 and 6 mos, Annually thereafter

  4. cost

    Measured: Baseline, 6 wks, 3 and 6 mos, Annually thereafter

Timeline

From the start of the study to its completion; the mark is today. Estimated dates are the sponsor’s plan.

  1. First posted4 Nov 1999 (estimated)
  2. Study startMar 2000
  3. Primary completionApr 2015
  4. Study completionApr 2015

Resources

More details

For doctors and researchers: how the study is designed, who runs it, and its registry IDs.

Study design
Study type
Interventional
Phase
Phase 4
Primary purpose
Treatment
Allocation
Randomised
Intervention model
Parallel groups
Masking
None (open label)
Enrolment
289 participants (actual)
IDs, dates and publications
ClinicalTrials.gov ID
NCT00000411
Sponsor's protocol ID
U01 AR45444 NIAMS-004B
Other IDs
U01AR045444
Status last verified
Aug 2015
First submitted
3 Nov 1999
Last updated
4 Aug 2015
Results posted
No
Data monitoring committee
Yes

Publications

  • Birkmeyer NJ, Weinstein JN, Tosteson AN, Tosteson TD, Skinner JS, Lurie JD, Deyo R, Wennberg JE. Design of the Spine Patient outcomes Research Trial (SPORT). Spine (Phila Pa 1976). 2002 Jun 15;27(12):1361-72. doi: 10.1097/00007632-200206150-00020.

    PubMed 12065987
  • Weinstein JN, Brown PW, Hanscom B, Walsh T, Nelson EC. Designing an ambulatory clinical practice for outcomes improvement: from vision to reality--the Spine Center at Dartmouth-Hitchcock, year one. Qual Manag Health Care. 2000 Winter;8(2):1-20. doi: 10.1097/00019514-200008020-00003.

    PubMed 10787504
  • Fanciullo GJ, Hanscom B, Weinstein JN, Chawarski MC, Jamison RN, Baird JC. Cluster analysis classification of SF-36 profiles for patients with spinal pain. Spine (Phila Pa 1976). 2003 Oct 1;28(19):2276-82. doi: 10.1097/01.BRS.0000084880.33281.EB.

    PubMed 14520044
  • Lurie JD, Birkmeyer NJ, Weinstein JN. Rates of advanced spinal imaging and spine surgery. Spine (Phila Pa 1976). 2003 Mar 15;28(6):616-20. doi: 10.1097/01.BRS.0000049927.37696.DC.

    PubMed 12642771
  • Walsh TL, Hanscom B, Lurie JD, Weinstein JN. Is a condition-specific instrument for patients with low back pain/leg symptoms really necessary? The responsiveness of the Oswestry Disability Index, MODEMS, and the SF-36. Spine (Phila Pa 1976). 2003 Mar 15;28(6):607-15. doi: 10.1097/01.BRS.0000050654.97387.DF.

    PubMed 12642770
  • Weinstein JN, Tosteson TD, Lurie JD, Tosteson AN, Blood E, Hanscom B, Herkowitz H, Cammisa F, Albert T, Boden SD, Hilibrand A, Goldberg H, Berven S, An H; SPORT Investigators. Surgical versus nonsurgical therapy for lumbar spinal stenosis. N Engl J Med. 2008 Feb 21;358(8):794-810. doi: 10.1056/NEJMoa0707136.

    PubMed 18287602
  • Weinstein JN, Tosteson TD, Lurie JD, Tosteson A, Blood E, Herkowitz H, Cammisa F, Albert T, Boden SD, Hilibrand A, Goldberg H, Berven S, An H. Surgical versus nonoperative treatment for lumbar spinal stenosis four-year results of the Spine Patient Outcomes Research Trial. Spine (Phila Pa 1976). 2010 Jun 15;35(14):1329-38. doi: 10.1097/BRS.0b013e3181e0f04d.

    PubMed 20453723
  • Tosteson AN, Lurie JD, Tosteson TD, Skinner JS, Herkowitz H, Albert T, Boden SD, Bridwell K, Longley M, Andersson GB, Blood EA, Grove MR, Weinstein JN; SPORT Investigators. Surgical treatment of spinal stenosis with and without degenerative spondylolisthesis: cost-effectiveness after 2 years. Ann Intern Med. 2008 Dec 16;149(12):845-53. doi: 10.7326/0003-4819-149-12-200812160-00003.

    PubMed 19075203
  • Tosteson AN, Tosteson TD, Lurie JD, Abdu W, Herkowitz H, Andersson G, Albert T, Bridwell K, Zhao W, Grove MR, Weinstein MC, Weinstein JN. Comparative effectiveness evidence from the spine patient outcomes research trial: surgical versus nonoperative care for spinal stenosis, degenerative spondylolisthesis, and intervertebral disc herniation. Spine (Phila Pa 1976). 2011 Nov 15;36(24):2061-8. doi: 10.1097/BRS.0b013e318235457b.

    PubMed 22048651
  • Desai A, Ball PA, Bekelis K, Lurie J, Mirza SK, Tosteson TD, Weinstein JN. SPORT: Does incidental durotomy affect longterm outcomes in cases of spinal stenosis? Neurosurgery. 2015 Mar;76 Suppl 1(0 1):S57-63; discussion S63. doi: 10.1227/01.neu.0000462078.58454.f4.

    PubMed 25692369
  • Desai A, Ball PA, Bekelis K, Lurie J, Mirza SK, Tosteson TD, Weinstein JN. SPORT: does incidental durotomy affect long-term outcomes in cases of spinal stenosis? Neurosurgery. 2011 Jul;69(1):38-44; discussion 44. doi: 10.1227/NEU.0b013e3182134171.

    PubMed 21358354

Questions about this trial

What is this clinical trial studying?

A Phase 4 study testing Decompressive laminectomy and Non-surgical treatments in people with Spinal Stenosis and Low Back Pain, run by Dartmouth-Hitchcock Medical Center at 13 sites in United States.

The full registered description is in the About this study section and the official record.

Who may be eligible to take part?

The sponsor lists 4 inclusion and 10 exclusion criteria. Eligibility is decided by the study team after screening, so read the full criteria and contact a listed site.

Is this clinical trial currently recruiting?

The record says: finished, as of the sponsor's last update on 4 Aug 2015. Status can change between updates, so confirm with the study contact before making plans.

Where is the study taking place?

The record lists 13 sites in United States. Whether a site is taking part right now should be confirmed with that site. See every site.

What are the possible benefits and risks?

They depend on the study and the treatment, and no study can promise a benefit. The study team explains the known risks during informed consent, before anyone joins; the record itself does not list them.

What does this phase mean?

Phase 4 studies take place after a treatment is approved, to learn more about its long-term benefits and risks in everyday use.

Not every study follows the same path, and some studies (observational studies, device studies) have no phase.

Are results available for this study?

The study is completed, but results are not available in the source record. That does not mean the treatment did or did not work.

How can a doctor refer a patient or contact the research team?

The record lists no contact. The official record names the sponsor, who can be asked directly. AzTrials does not enrol participants or take referrals.

What does the primary outcome measure?

Changes in health-related quality of life as measured by the SF-36 health status questionnaire (time frame: Baseline, 6 wks, 3 and 6 mos, Annually thereafter). It is what the study was designed to measure, not a finding.

Where can I read the original study information?

On the ClinicalTrials.gov record for NCT00000411, which also lists 11 linked publications.

Does a listing mean the treatment is approved or proven to work?

No. A listing means the study is registered. It does not show that the treatment is safe, works, or is approved by a regulator.

How often is this information updated?

AzTrials copies changed records from ClinicalTrials.gov every night and reloads the whole registry every week. The sponsor last updated this record on 4 Aug 2015.

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