Long-term Pain and Function Outcomes Associated With Lumbar Spine Surgery for Chronic Low Back Pain: A Target Trial...

Area of Science:

• Spine surgery outcomes research
• Real-world evidence in orthopedics
• Chronic low back pain management

Background:

• Randomized controlled trials for lumbar spine surgery present methodological challenges.
• Real-world data from observational databases offer an alternative for evidence generation.
• This study evaluated long-term pain and functional outcomes of lumbar spine surgery versus usual care for chronic low back pain.

Purpose of the Study:

• To assess the long-term effectiveness of lumbar spine surgery compared to usual care for chronic low back pain.
• To provide evidence for surgical decision-making when randomized controlled trials are not feasible.

Main Methods:

• A target trial emulation was conducted using data from the national Pain Registry (April 2016-April 2025).
• Propensity scores matched 75 patients undergoing lumbar spine surgery with 75 patients receiving usual care.
• Pain and function were assessed up to 36 months using the Numerical Rating Scale and Roland-Morris Disability Questionnaire.

Main Results:

• Patients undergoing lumbar spine surgery reported significantly less pain intensity (mean 5.6 vs. 6.2, P=0.02) over 36 months.
• The observed pain reduction was clinically relevant (Cohen d = 0.32).
• No significant differences in back-related disability (function) were found between the surgical and usual care groups.

Conclusions:

• Lumbar spine surgery demonstrated a clinically relevant improvement in pain intensity for up to 3 years compared to usual care.
• No comparable benefit in functional outcomes was observed with lumbar spine surgery.
• Target trial emulation using high-quality observational data is a viable method for generating evidence when RCTs are challenging.