James M. Parrish, Nathaniel W. Jenkins, Manasi S. Parrish, Elliot D. K. Cha, Conor P. Lynch, Dustin H. Massel, Nadia M. Hrynewycz, Shruthi Mohan, Cara E. Geoghegan, Caroline N. Jadczak, Jennifer Westrick, Rebecca Van Horn, Kern Singh

May 2021, Volume 30, Issue 5, pp 1365 - 1379 Review Article Read Full Article 10.1007/s00586-021-06747-x

First Online: 10 February 2021

The influence of cognitive behavioral therapy on lumbar spine surgery outcomes: a systematic review and meta-analysis


As more patients undergo lumbar spine surgery, novel interventions may improve physical and mental health outcomes. Few studies summarize the benefit of cognitive behavioral therapy (CBT) among lumbar spine surgery patients. This study collects randomized control trial data to investigate the influence of CBT on patient reported outcomes among lumbar spine surgery patients.


Our study used the Preferred Reporting Items for Systematic Reviews and Meta-Analyses and a medical library expert assisted in searching PubMed/MEDLINE, Scopus, CINAHL, Cochrane Central Register of Controlled Trials, Cochrane Database of Systematic Reviews, PsycINFO, and Google Scholar. We calculated standardized mean differences (SMD) to evaluate the effect size of CBT versus control groups with a sensitivity analysis.


Our meta-analysis included seven studies with a total of 531 patients. The majority of included studies evaluated lumbar fusion, with preoperative CBT performed by physiotherapists. The largest effects were observed for overall quality of life (SMD = 0.55 [95% CI 0.05, 1.05], p 


Compared to usual care or alternative therapy control arms, CBT delivered the most improvement with overall quality of life and psychological outcomes. Among appropriately selected patients, CBT could improve perioperative disability, pain, quality of life, and psychological health following lumbar spine surgery.

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