Functional Outcomes of Intensive Rehabilitation Versus Fusion Surgery in Patients With Low Back Pain Due to Lumbar Degenerative Spine Disease: A Systematic Review and Meta-Analysis

Lumbar degenerative disease is mostly managed non-operatively, but lumbar spinal fusion has been used for almost a century. It has shown clinical efficacy in decreasing pain and disability scores and allowing patients to return to work. However, spinal fusion may not be clinically effective and may place a financial burden on patients. The alternative to spinal fusion is physical therapy and rehabilitation for lumbar degenerative diseases. This study aims to compare the functional outcomes of intensive rehabilitation and lumbar spine fusion surgery among patients with chronic low back pain from lumbar spine degenerative disease. We conducted a systematic search of clinical trials on the topic, followed by a meta-analysis using a random-effects model. The functional outcomes compared included the Oswestry Disability Index (ODI) score, improvement in low back pain and leg pain, as well as overall patient outcome. Five randomized controlled trials were included in the meta-analysis. There was a 7.25-point improvement in the change in the ODI (95% CI: 1.22-13.17; p = 0.02; I² = 98%), favoring fusion surgery. All studies showed improvement in low back pain, with a VAS score change of 11.49, favoring fusion surgery (95% CI: 4.48-18.50; p = 0.001; I² = 96%). There was a Visual Analog Scale (VAS) score change of 7.2 in leg pain improvement (95% CI: -8.58 to 22.97; p = 0.37; I² = 98%); however, the effect was not significant. There was no significant difference in terms of overall patient outcome (95% CI: 0.23-1.08; p = 0.08; I² = 78%). Among patients with chronic low back pain, lumbar spine fusion surgery showed improvement in functional outcomes related to changes in disability and low back pain when compared with intensive rehabilitation. However, the two treatment options showed no differences with respect to improvement in leg pain and overall patient outcome.