Objectively measured physical activity following lumbar decompression surgery: systematic review and meta-analysis

Lumbar decompression surgery reliably improves pain and disability in lumbar disc herniation and spinal stenosis, but whether these symptomatic gains translate into greater free-living physical activity (PA) remains unclear. This systematic review and meta-analysis evaluates postoperative changes in objectively measured PA, and its association with patient-reported outcome measures (PROMs). PubMed, MEDLINE, EMBASE and Scopus databases were searched to identify studies reporting objectively measured PA after lumbar decompression, including laminectomy, laminotomy, foraminotomy and discectomy. Ten studies (n = 549) met inclusion criteria, with six (n = 199) included in a random-effects meta-analysis of standardised mean change (SMC) in PA volume at 3 and 6 months. Meta-analysis demonstrated small, non-significant improvements in PA volume at 3 months (SMC 0.26; 95% CI -0.16, 0.69) and 6 months (SMC 0.25; 95% CI -0.13, 0.63). PA volume followed a consistent pattern: an early postoperative decline, followed by recovery to pre-operative levels by 3–4 months. There were limited behavioural shifts towards higher activity intensities. Correlations between PA and PROMs were weak and inconsistent. Objectively measured PA shows limited and heterogeneous recovery after lumbar decompression despite marked symptomatic improvement. Further work should standardise PA measurement and evaluate behavioural interventions to support postoperative activity.