The Impact of Restorative Neurostimulation on Outcomes in Low Back Pain Management: Systematic Literature Review With Meta-analysis

Bakbayeva A. Tungushpayev M. Sarria-Santamera A. Viderman D.
2026 International Neuromodulation Society

Neuromodulation
2026

Introduction Chronic low back pain (CLBP) is a leading cause of global disability and is frequently associated with dysfunction of the lumbar multifidus muscle. For patients whose condition is unresponsive to conservative treatments or ineligible for surgery, restorative neurostimulation offers a minimally invasive approach targeting the medial branch nerve to restore multifidus function. This review aimed to synthesize the available evidence on pain, functional outcomes, and quality of life in patients with multifidus-related CLBP who underwent restorative neurostimulation. Materials and Methods A systematic review and meta-analysis were conducted in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Randomized and nonrandomized studies reporting outcomes on pain, disability, or quality of life were included. Searches were performed across PubMed, Scopus, and the Cochrane Library. Risk of bias was assessed using the Risk Of Bias In Non-randomized Studies - of Interventions V2 tool, with data synthesis completed in RevMan Web. The Grading of Recommendations Assessment, Development, and Evaluation approach was used to evaluate the certainty of evidence. Results Overall, 15 prospective studies met the inclusion criteria. Restorative neurostimulation was associated with significant improvements in pain (numeric rating scale, visual analog scale), disability (Oswestry Disability Index), and quality of life (EuroQol 5-Dimension 5-Level). Despite outcomes exceeding clinically meaningful thresholds, the certainty of evidence was limited owing to study design and potential biases. Conclusion Restorative neurostimulation may be beneficial for patients with refractory CLBP who are not candidates for surgery. Confirmation of its long-term efficacy and clinical utility requires further high-quality, independently conducted randomized controlled trials.

Chronic low back pain , multifidus dysfunction , neuromodulation , pain management , restorative neurostimulation

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Department of Surgery, School of Medicine, Nazarbayev University, Astana, Kazakhstan
Department of Anesthesiology, Intensive Care, and Pain Medicine, National Research Oncology Center, Astana, Kazakhstan

Department of Surgery
Department of Anesthesiology

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