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I just did the two articles for my journal club yesterday. I think we all concluded that surgery and nonoperative care were fairly equal and that had they standardized or improved the nonoperative care arm of the study, they may have had even better outcomes. The Attendings thought that it supported what we do best: nonoperative care of back pain. It would have been nice if they had done a neater job of data collection without all the missing data and had collected info on the various types of nonoperative care i.e. injections, therapy, chiro, etc. the number of turnover also shows that maybe there's a window of time when ppl reach a threshold whichever way. it was also curious that the patients enrolled in the study had to have had symptoms for more than 6 wks but no where in table 1 do they show the mean duration - I think there's a category for >6months of symptoms... Also, these patients presented at a spine center to surgeons. Had they actually designed the study to enroll patients at the PCP level - where they were randomly referred to either physiatrists(or nonoperative care) or orthopedic surgeons, that would have been a very interesting study. 
