Evaluating Rehabilitation Outcomes After Lumbar Fusion Surgery: A Systematic Review and Meta-Analysis

Study Design-A systematic review with meta-analysis. Objective-This study aims to conduct a systematic review and meta-analysis to evaluate the effectiveness of rehabilitation following lumbar fusion surgery (LFS). Background-LFS is increasingly performed for the management of lower back pain, with or without neurogenic leg pain, particularly as the population ages. However, clinical outcomes often lag behind surgical outcomes, and approximately 40% of patients continue to experience significant back-related disability 12 months after surgery. Identifying effective rehabilitation strategies to enhance function and quality of life post-LFS is crucial. Methods-A systematic review was conducted using multiple databases, including MEDLINE, CINAHL, and grey literature sources. Studies were screened for inclusion based on title and abstract, followed by full-text evaluation against predefined eligibility criteria. Included studies underwent critical appraisal and risk of bias assessment. The GRADE approach was used to assess the quality of evidence. A meta-analysis compared "complex rehabilitation" (combining exercise and cognitive behavioral therapy) with usual care, evaluating outcomes related to pain, disability, fear of movement, and mental health at both short-term (<3 months) and long-term (>12 months) follow-up. Results-Three studies were included in the systematic review, with two eligible for meta-analysis (total participants: 237; female: 62%; mean age: 55 years). Low-quality evidence suggests that "complex rehabilitation" provides short-term improvements in disability (effect size: -0.85, 95% CI: -1.41 to -0.29) and fear-avoidance behavior (-1.07, 95% CI: -1.33 to -0.80) compared to usual care. Similarly, low-quality evidence supports the benefits of "complex rehabilitation" for long-term disability (-0.84, 95% CI: -1.11 to -0.58) and fear-avoidance behavior (-1.40, 95% CI: -1.69 to -1.12) Conclusion-Although limited by the small number of low-quality studies, findings suggest that "complex rehabilitation" may reduce both short- and long-term disability and fear-avoidance behaviour following LFS. However, further high-quality research is needed to confirm the effectiveness of such rehabilitation programs.