Efficacy of Neuromodulation in Postoperative Acute and Chronic Low Back Pain after Lumbar Spine Surgery: A Systematic...

Acute and chronic postoperative low back pain are frequent occurrences after lumbar spine surgery, contributing to long-term disability and increased analgesic use. Neuromodulation techniques-both invasive and non-invasive-have emerged as promising non-pharmacological interventions. However, current evidence remains fragmented. This systematic review and meta-analysis aimed to evaluate the effectiveness and safety of neuromodulation in managing acute and chronic postoperative low back pain.

We systematically searched PubMed, Scopus, and Cochrane databases from inception up to 30 June 2025 for randomized controlled trials (RCTs) published in English only comparing neuromodulation to sham modulation in patients with postoperative low back pain following lumbar spine surgery. The review protocol was registered in PROSPERO (CRD420251108776). Primary outcomes included pain intensity reduction, analgesic consumption, functional disability, and adverse effects. Standardized mean differences (SMDs) with 95% confidence intervals (CIs) for continuous outcomes were calculated using a frequentist random-effects model. Proportions and 95% CIs for binary outcomes, including adverse events and sex distribution, were computed using the Freeman-Tukey double arcsine transformation to stabilize variance. Heterogeneity was assessed using the I²  statistic and Cochrane's Q test.

Twelve RCTs involving 413 patients (mean age 53 years; 55 % female) were included, with 207 (50%) receiving neuromodulation. In the pooled analysis, neuromodulation significantly reduced pain intensity (SMD - 0.82; 95 % CI [-1.13, -0.50]; p < 0.00001; I² = 53 %) and analgesic consumption (SMD - 0.91; 95 % CI [-1.63, -0.20]; p = 0.01; I² = 81 %) compared to sham. No significant difference was found in functional disability (SMD - 0.31; 95 % CI [-0.85, 0.24]; p = 0.28; I² = 44 %). The pooled female proportion was 55 % (95 % CI [42.99, 66.95]; I² = 73 %), and the prevalence of adverse effects was 12.48 % (95 % CI [6.13, 20.39]; I² = 0 %).

This meta-analysis demonstrates that neuromodulation significantly reduces postoperative pain and opioid consumption after lumbar spine surgery, although it does not improve functional disability. Given the growing need for non-pharmacological pain management strategies, neuromodulation represents a promising evidence-based adjunct in postoperative care. Future high-quality RCTs should refine optimal protocols and evaluate long-term functional outcomes.