Sleep quality after lumbar surgery for degenerative lumbar disease: a systematic review and Bayesian meta-analysis with meta-regression.

Abstract

Sleep disturbances are common in patients with degenerative lumbar disease, yet the effect of surgical treatment on sleep recovery remains insufficiently quantified. This meta-analysis evaluated postoperative changes in sleep quality, pain, disability, and quality of life (QoL) following lumbar spine surgery. PubMed, Scopus, and the Cochrane Library were searched up to 1 March 2026 for studies reporting pre- and postoperative outcomes in adults undergoing surgery for degenerative lumbar pathologies. A Bayesian random-effects model with vague priors for overall effects and weakly informative priors for between-study heterogeneity were applied. Sensitivity analyses with alternative priors and subgroup analyses by study design, risk of bias, mean age, procedure, and pathology were performed. Posterior probabilities (PP), 95% credible intervals (CrIs), and posterior predictive distributions were estimated. Twenty-five studies comprising 3,546 patients were included. Surgery was associated with improvement in sleep quality (SMD - 1.36; 95% CrI - 2.02 to - 0.71; PP 99%). Significant reductions were observed in back pain (MD - 3.73; 95% CrI - 4.75 to - 2.69; PP 99%), leg pain (MD - 3.44; 95% CrI - 4.47 to - 2.40; PP 99%), disability (MD - 18.95; 95% CrI - 26.41 to - 11.48; PP 99%), and improved QoL (SMD 1.09; 95% CrI 0.23 to 1.95; PP 99%). Meta-regression suggested that pathology and risk of bias contributed to heterogeneity, whereas age, procedure, and study design had limited influence. This Bayesian meta-analysis found that lumbar surgery for degenerative lumbar disease is associated with improvements in sleep quality, pain, disability, and QoL, supporting the inclusion of sleep outcomes in perioperative assessment.