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Comprehensive guidelines for prehabilitation in spine surgery.
Paulomi Gohel1, Raj Swaroop Lavadi1, Mohamed-Ali H Jawad-Makki1
1Department of Neurosurgery, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA.
Journal of Craniovertebral Junction & Spine
|April 28, 2025
Summary
Optimize elective spine surgery outcomes with prehabilitation. Key interventions include smoking cessation, weight loss, exercise, alcohol abstinence, nutritional support, opioid weaning, and cognitive behavioral therapy for improved patient recovery.
Area of Science:
- Spine Surgery
- Prehabilitation Medicine
- Evidence-Based Practice
Background:
- Elective spine surgery patients often face significant postoperative complications.
- Prehabilitation strategies aim to mitigate these risks by optimizing patient health before surgery.
Purpose of the Study:
- To systematically review and synthesize prehabilitation techniques for elective spine surgery.
- To develop a comprehensive list of evidence-based recommendations for prehabilitation.
Main Methods:
- Systematic literature review following PRISMA guidelines.
- Searched three databases (1997-2021) for studies on prehabilitation in spine surgery.
- Analyzed 70 selected studies, integrating findings with authors' clinical practices.
Main Results:
- Recommended preoperative smoking cessation (3-4 weeks prior).
- Advocated for weight loss programs (BMI <35 kg/m²), exercise for cardiopulmonary health, and alcohol abstinence.
- Suggested Vitamin D, calcium, and parathyroid hormone for osteoporosis; opioid weaning (6-8 weeks prior); and cognitive behavioral therapy (CBT) for psychiatric comorbidities.
Conclusions:
- Comprehensive prehabilitation regimens are crucial for patients undergoing elective spine surgery.
- Personalized interventions targeting patient risk factors significantly improve postoperative outcomes.
