Pain and disability after first-time spinal fusion for lumbar degenerative disorders: a systematic review and meta-analysis

Niek Koenders, Alison Rushton, Martin L. Verra, Paul C. Willems, Thomas J. Hoogeboom, J. B. Staal

Research output: Contribution to journalArticlepeer-review

11 Citations (Scopus)
149 Downloads (Pure)

Abstract

Purpose: Lumbar spinal fusion (LSF) is frequently and increasingly used in lumbar degenerative disorders despite conflicting results and recommendations. A thorough understanding of patient outcomes after LSF is required to inform decisions regarding surgery and to improve post-surgery management. The current study aims to evaluate the course of pain and disability in patients with degenerative disorders of the lumbar spine after first-time LSF. Methods: A systematic review and meta-analysis of pain and disability outcomes in prospective cohort studies up to 31 March 2017 is identified in four electronic databases. Two independent researchers determined study eligibility, extracted data, and assessed risk of bias (modified Quality in Prognostics tool). A random effects model (maximum likelihood) was used to calculate means and 95% confidence intervals. The primary analysis was performed on complete data, and a sensitivity analysis was performed on all data. Results: Twenty-five studies (n = 1777 participants) were included. The mean (95% confidence interval) Visual Analogue Scale (VAS) back pain (n = 9 studies) decreased from 64 (57–71) pre-surgery to 20 (16–24) at 24-month follow-up. Leg pain (n = 9 studies) improved from VAS 70 (65–74) pre-surgery to 17 (12–23) at 24-month interval. Disability (n = 12 studies), measured with the Oswestry Disability Index, decreased from 44.8 (40.1–49.4) pre-surgery to 17.3 (11.9–22.8) at 24-month follow-up. The sensitivity analysis yielded similar results. Conclusion: There is a substantial improvement in pain and disability after first-time LSF for degenerative disorders. However, long-term outcomes indicate that leg pain might be more reduced and for a longer period of time than axial back pain and disability. Registration PROSPERO CRD42015026922. Graphical abstract: These slides can be retrieved under Electronic Supplementary Material.[Figure not available: see fulltext.]

Original languageEnglish
Pages (from-to)1-14
Number of pages14
JournalEuropean Spine Journal
Early online date11 Jul 2018
DOIs
Publication statusE-pub ahead of print - 11 Jul 2018

Keywords

  • Discogenic low back pain
  • Herniated disc
  • Pain
  • Spinal fusion
  • Spinal stenosis
  • Spondylolisthesis

ASJC Scopus subject areas

  • Surgery
  • Orthopedics and Sports Medicine

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