Functional Outcomes of Intensive Rehabilitation Versus Fusion Surgery in Patients With Low Back Pain Due to Lumbar Degenerative Spine Disease: A Systematic Review and Meta-Analysis.
Level 1 - systematic review of randomized trials
Systematic review and meta-analysis of randomized controlled trials
PubMed 41769568 · doi:10.7759/cureus.102509
What was done
A systematic review and random-effects meta-analysis was performed using randomized controlled trials comparing intensive rehabilitation with lumbar spinal fusion in patients with chronic low back pain from lumbar degenerative spine disease. Analyzed outcomes included the Oswestry Disability Index (ODI), back pain and leg pain Visual Analog Scale (VAS) scores, and overall patient outcomes.
What was found
Five randomized controlled trials were included. Fusion surgery was associated with a statistically significant 7.25-point greater improvement in ODI (95% CI: 1.22-13.17; p = 0.02; I² = 98%) and an 11.49-point greater improvement in low back pain VAS (95% CI: 4.48-18.50; p = 0.001; I² = 96%) compared to rehabilitation. No statistically significant differences were observed for leg pain VAS improvement (score change 7.2; 95% CI: -8.58 to 22.97; p = 0.37; I² = 98%) or overall patient outcome (95% CI: 0.23-1.08; p = 0.08; I² = 78%).
Why it matters
This review synthesizes trial evidence on whether surgical fusion provides superior functional recovery over intensive non-operative therapy, finding modest advantages in back pain and disability that must be balanced against surgical risks.
Limits
The total number of randomized patients is not reported in the abstract. All meta-analyzed outcomes demonstrated severe statistical heterogeneity (I² = 78% to 98%). The abstract does not provide data on adverse events, complication rates, reoperations, or long-term follow-up.
Cited by
- context Spinal fusion surgery for chronic back pain does not work at least half of the time.