The PORT Trial (The Spine Patient Outcomes Research Trial) is a large, multicenter, controlled study of the clinical outcomes and cost-effectiveness of conservative versus surgical treatment of degenerative low back pain in the United States. The trial was funded by the NIH and led by Professor James Weinstein, editor-in-chief of SPINE, the journal of spine surgery at Dartmouth Medical School, and was initiated over a period of approximately 8 years, with 2,505 patients followed and a total cost of approximately $15 million[1]. Engl J Med, JAMA, Ann Intern Med, Spine and other world-renowned clinical medical journals, it is necessary for our spine surgeons to be aware of this study. The main objective of the SPORT trial was to compare the clinical outcomes of conservative versus surgical treatment for the three major degenerative lumbar spine diseases, lumbar disc herniation, lumbar spinal stenosis, and degenerative lumbar spondylolisthesis, and the resulting low back pain, as well as the cost-benefit ratio between the two. Participants included 13 large spine surgery centers including Dartmouth Medical Center, Cornell University Hospital for Special Surgery in New York, New York University Hospital for Joint Diseases, Rothman Orthopaedics in Philadelphia, Washington University Medical Center in St. Louis, Rush University Orthopaedics in Chicago, Emory University in Atlanta, University Hospital in Cleveland, and UCSF Medical Center Spine Surgery centers, covering all major regions of the United States. The trial design was a randomized controlled clinical trial as well as a prospective cohort study with observations including the SF-36 and ODI scales [2]. The results of the cohort observation of conservative versus surgical treatment of lumbar disc herniation showed that both conservative and surgical treatment had significant clinical outcomes, with the surgical group having an advantage over the conservative group [3]. While the randomized controlled study showed that both had significant clinical outcomes at 4-year follow-up, the surgical group appeared to have a slight advantage over the conservative group, but there was no statistical difference. However, it remains to be further investigated whether the surgical group had more clinical outcomes than the conservative group due to the large amount of group crossover that occurred during the trial [4,5]. Combining the results of the two studies, both conservative management and surgical treatment are effective methods for treating lumbar disc herniation, but there is still no clear answer as to which is superior, and caution is still needed in selecting surgical indications. a 2-year cost-benefit ratio analysis showed that the cost-effectiveness of surgical treatment was relatively lower than that of the conservative treatment group [6]. Studies of conservative versus surgical treatment of degenerative lumbar spondylolisthesis have shown that surgical treatment shows more significant clinical outcomes in both cohort observations and randomized controlled trials. Follow-up results at 6 weeks, 3 months, 6 months, 1 year, 2 years, and 4 years after surgery showed that the surgical treatment group was superior to conservative treatment [7]. Also, the cost-benefit ratio analysis at 2 years showed that the cost-benefit ratio of surgical treatment was not high and was more economical in the long term [8]. Therefore, the treatment of lumbar spondylolisthesis and its resulting low back pain should be primarily surgical. Similarly, the 2-year follow-up results of lumbar spinal stenosis showed that surgical treatment was superior to conservative treatment [9]. Although the above findings suggest that overall surgical treatment has better clinical outcomes than conservative treatment, the value of this large trial is still controversial in the American spine surgery community. Scholars, represented by Edward Hanley, have argued that the SPORT trial had the following problems: (1) the trial could not be blinded for ethical reasons; (2) conservative treatment was not uniform; (3) multiple experimental biases could not be eliminated; (4) differences in patient expectations between conservative and surgical treatment led to bias in scale scores; (5) conservative treatment of lumbar disc herniation patients in the conservatively treated and surgically treated groups had different levels of preoperative symptoms; (6) a large number of group crossovers in the randomized controlled trial; the above problems resulted in the results of the SPORT trial not being 100% reliable. In addition, the results of the trial did not differ significantly from clinical experience, and there is still no uniform answer as to whether it is worth spending $15 million to validate an experience that most clinicians recognize [1]. However, most scholars believe that spine surgeons provide a useful reference. The findings of the SPORT trial have provided high-level evidence-based medical evidence for the selection of treatments by US spine surgeons and have become the standard for evaluating the results of various similar spine clinical trials in the future, as well as providing a useful reference for the US government to develop health care reform programs. the process of the SPORT trial, as well as the results, have enlightened our country that currently in the absence of similar evidence-based medical evidence Our government, as well as our colleagues, should conduct such studies when conditions permit, to provide a theoretical basis for rational treatment plans for the national conditions.