JMIR Publications

ABSTRACT

Background:

Spinal disorders are associated with persistent or perioperative pain, fear of movement, anxiety, functional limitation, and impaired health-related quality of life. Immersive virtual reality (IVR), delivered through head-mounted displays (HMDs), can combine attentional distraction, graded exposure, behavioral skills training, relaxation, and sensorimotor feedback. However, the evidence relevant to symptom management in spinal populations is fragmented across low back pain, neck pain, and spinal cord injury literatures, while many prior reviews combine immersive and nonimmersive technologies.

Objective:

Objective:

To systematically review randomized evidence on HMD-based IVR interventions for symptom management in adults with spinal disorders, with emphasis on pain, anxiety or fear-related symptoms, quality of life, disability, functional outcomes, adherence, and IVR-related adverse events.

Methods:

Methods:

We designed the review in accordance with PRISMA 2020 and structured the quantitative narrative synthesis according to the Synthesis Without Meta-analysis (SWiM) reporting guideline. The prespecified eligibility framework included adults with spinal disorders or spinal cord injury–related symptom burden; HMD-based immersive VR interventions; randomized or randomized crossover comparisons; and patient-centered symptom or functional outcomes. Searches were executed in PubMed/MEDLINE, Europe PMC, Web of Science Core Collection, OpenAlex (open multidisciplinary index), and CNKI (China National Knowledge Infrastructure; Chinese-language subject-field search) from database inception to 30 September 2026, complemented by backward and forward citation chasing of the included studies. Risk of bias was assessed with the Cochrane Risk of Bias 2 (RoB 2) tool.

Results:

Results:

Thirteen published randomized studies were identified as reasonably compatible with the strict immersive-HMD eligibility concept, spanning chronic low back pain, chronic neck pain, lumbar disc herniation, and spinal cord injury–related neuropathic pain. Across chronic low back pain, skills-based or embodied IVR showed clinically promising improvements in pain interference, fear of movement, disability, or related outcomes in several trials, although a large 2026 three-arm trial found no superiority of active skills-based or distraction IVR over sham VR for the primary pain-interference outcome. For chronic neck pain, several HMD-based sensorimotor or kinematic-training trials improved selected range-of-motion, proprioceptive, disability, or quality-of-life outcomes, but effects on pain were inconsistent and newer trials found little or no incremental benefit over conventional exercise. In spinal cord injury, small randomized trials suggest short-term reductions in neuropathic pain and improvements in embodiment/depersonalization-related outcomes. A 2025 randomized trial in lumbar disc herniation reported improvements in pain, disability, and quality of life after VR-based exercise. Adverse effects were generally mild and self-limited when reported, with cybersickness, dizziness, nausea, or discomfort being the most relevant IVR-specific concerns.

Conclusions:

Conclusions:

HMD-based IVR is a plausible adjunct for symptom management in selected spinal populations, particularly when the intervention explicitly targets pain coping, fear avoidance, relaxation, graded movement, or sensorimotor retraining. The evidence does not support a single uniform effect across all spinal disorders or all IVR modalities. The most defensible clinical interpretation is that benefit is mechanism- and context-dependent, with stronger signals for psychological and functional symptom modulation than for structural disease outcomes. Larger multisite RCTs, standardized IVR reporting, longer follow-up, and clearer separation of immersive from nonimmersive VR are needed.