Chronic and Acute Low Back Pain After Spinal Anesthesia: A Systematic Review and Meta-analysis

Abstract

Context: Spinal anesthesia is commonly used for many surgical procedures because of its rapid onset and reliable anesthetic effects. Nevertheless, postoperative lower back pain (LBP) remains a frequent complication, with reported rates varying substantially across the literature. This systematic review and meta-analysis aimed to synthesize the available evidence and estimate the overall incidence of both short-term acute and long-term persistent LBP following spinal anesthesia. Evidence Acquisition: Major databases, including PubMed, Scopus, Embase, and Web of Science, were systematically searched to identify studies of LBP after spinal anesthesia. Following data extraction, relevant outcomes were pooled for analysis. Given the expected methodological heterogeneity across studies, a random-effects model was used for data synthesis. Between-study heterogeneity was quantified using Cochran's Q test and the I2 statistic. Publication bias was assessed using funnel-plot inspection and established statistical methods. Results: The review included 15 studies comprising 4,478 patients, of which 11 provided sufficient data for meta-analysis. The pooled overall rate of postprocedural LBP was 25.65% (95% CI: 19.54% - 32.29%), with substantial between-study heterogeneity (I2 = 96.84%). Subgroup analyses showed an acute LBP prevalence of 21.96% (95% CI: 16.01% - 28.56%) and a chronic LBP prevalence of 44.98% (95% CI: 26.95% - 63.73%). Marked heterogeneity persisted across these subgroups. Most included studies involved orthopedic, urologic, or obstetric/gynecologic surgery.