Enhanced Recovery After Surgery and Perioperative Optimization in Adult Cervical Deformity Surgery

Adult cervical spinal deformity (ACSD) correction surgery remains among the most complex interventions in adult spine surgery with historically high morbidity and suboptimal recovery. Enhanced recovery after surgery (ERAS) protocols, developed to improve surgical outcomes through multimodal perioperative care, have been established in other surgical models, including orthopedics, but are not well-established in cervical deformity surgery. The purpose of this review paper is to synthesize the current data on ERAS protocols and outcomes in ACSD, focusing on prehabilitation, perioperative opioid management, intraoperative strategies, surgical site infection (SSI) prevention, and early postoperative mobilization.

We present data from recent retrospective and prospective studies, review the core components of ACSD ERAS pathways, propose future research studies, and potential clinical applications. This review synthesizes findings from 10 peer-reviewed studies selected for their methodological rigor and relevance to perioperative care in adult cervical spine deformity, including retrospective cohorts, prospective studies, and systematic reviews.

Overall findings from these studies have demonstrated ERAS protocols in ACSD are associated with reduced blood loss, operative time, opioid use, and complication rates, along with improved functional outcomes, patient-reported quality of life, and reduced SSI.

Early findings support the formal development of ERAS protocols in ACSD patients and should be implemented as appropriate to each institution; however, further multicenter validation and protocol standardization are warranted to ensure comparable experiences and external validity of ERAS.