"Prehabilitation" in degenerative spine surgery: A literature review

Surgery for lumbar degenerative pathology, although effective, results in suboptimal outcome and degrees of disability in a relevant proportion of patients. Postoperative rehabilitation has failed to demonstrate efficacy in the mid and long term. So-called "prehabilitation" (physiotherapy and/or cognitive-behavioral therapy) focuses in augmenting patients' functional capacities before surgery by improving their physical condition and their perception of pain, surgical experience or its consequences. Several studies suggest that prehabilitation improves postoperative outcome, shortens hospital stay and may reduce costs compared to classic postoperative rehabilitation. However, its true effect seems to be influenced by factors like obesity, co-morbidity and, especially, by a wrong perception of the natural history of this pathology in terms of catastrophising and kinesiphobia. In this paper we describe the concept of prehabilitation, review the literature, and discuss the role of some clinical conditionings involved.