Introduction: Chronic low back pain (CLBP) is a pervasive health issue that substantially diminishes patients' quality of life and functional capacity. Surgical (e.g., lumbar fusion) and nonoperative treatments are used to manage CLBP, yet lumbar fusion's comparative efficacy and safety remain subjects of ongoing debate. This study aims to evaluate the outcomes of lumbar fusion compared with nonoperative care to provide clearer insights for clinical decision-making.
Methods: This systematic review and meta-analysis adhered to PRISMA guidelines. We searched PubMed, Cochrane Central, Scopus, and Web of Science databases through August 2024. Eligible studies were screened, and relevant data were extracted. The risk of bias was assessed using the Cochrane Collaboration tool. Primary outcomes included the Oswestry Disability Index (ODI) and Visual Analog Scale (VAS) for back pain. Data from relevant randomized controlled trials (RCTs) were analyzed using RevMan software (version 5.4.1 for Windows).
Results: Eleven RCTs comprising 1,370 patients met the eligibility criteria for the final analysis. For primary outcomes, the mean difference (MD) in ODI scores from baseline to endpoint favoured lumbar fusion, with more pronounced effects over longer follow-ups. In comparison with < 2-year follow-up, the standardized mean difference (SMD) for ODI was -0.10 (95% CI, -0.28 to 0.08; P=0.26). At >2 years, lumbar fusion showed significant improvement (SMD = -0.80, 95% CI, -1.48 to -0.11; P=0.02) using a random-effects model. Similar trends were observed for VAS scores, with improvements favouring lumbar fusion after two years (SMD = -0.46, 95% CI, -0.91 to -0.02; P=0.04).
Conclusion : The findings indicate that lumbar fusion may offer incremental benefits over nonoperative care in terms of pain reduction and functional improvement, with statistically significant effects emerging over longer follow-up periods. These results suggest that while lumbar fusion may provide enhanced relief over time, careful consideration of individual patient factors and longer-term monitoring remain essential to optimize treatment outcomes for chronic low back pain.
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