Lightning Presentation Sydney Spinal Symposium 2026

Interventions for chronic pain after lumbar spine surgery: a systematic review and meta-analysis (#143)

Jordan Hamilton 1 , Joshua Zadro 2 , Christopher Maher 2 , Ian Harris 3 , Navneet Chadha 2 , Giovanni E Ferreira 2
  1. The University of Sydney, Camperdown, NSW, Australia
  2. Institute for Musculoskeletal Health, Institute for Musculoskeletal Health, Sydney Local Health District & The University of Sydney, Sydney, NSW, Australia
  3. Ingham Institute of Applied Medical Research, Southwestern Sydney Local Health District and University of New South Wales, Sydney, NSW, Australia

Background: Chronic pain after lumbar spine surgery affects approximately 8%-40% of people undergoing lumbar surgery and is associated with a substantial disability burden. Numerous trials have evaluated a broad range of interventions in this population, but no comprehensive synthesis of all available trial evidence exists to guide clinical care.

Aim: To investigate the effectiveness of interventions for chronic pain after lumbar spine surgery on pain and disability.

Methods: Systematic review with meta-analysis, prospectively registered (CRD42024507588). We searched multiple databases from inception to 4 May 2026 for randomised controlled trials investigating any intervention for adults with chronic pain after lumbar spine surgery, as defined by each study, following one or more lumbar spine surgeries. Trials reporting only short-term outcomes (<3 months) were excluded. Outcomes were pain (primary) and disability, collected at 3, 6, and 12 months post-randomisation. Risk of bias was assessed using the ROBUST-RCT tool. Studies were classified into three broad intervention categories: conservative, interventional, and surgical. Studies comparing a similar intervention to placebo, sham, an adjuvant intervention, or usual care were grouped and pooled using random-effects meta-analyses where >2 trials were available. Head-to-head trials were also eligible but presented descriptively only. Certainty of evidence was assessed using GRADE.

Results: We included 42 trials (2,985 participants). All trials were at high risk of bias. Most investigated interventional treatments (29 trials), followed by conservative (9) and surgical (1) approaches. Evidence for most interventions was based on only 1–2 small trials (combined samples <200 participants). Some interventions showed potential benefits for pain and/or disability (e.g. gabapentin, exercise, trigger point injections, epidural adhesiolysis, epidural hyaluronidase injection, spinal cord stimulation), but the evidence was very uncertain for all comparisons and outcomes.

Conclusion: Despite numerous trials, the evidence remains too uncertain to guide treatment decisions in this population. Larger, high-quality trials are urgently needed.