Prehabilitation and preoperative exercise in adolescent idiopathic scoliosis surgery: a systematic review

Adolescent idiopathic scoliosis (AIS) is a three-dimensional spinal deformity that can lead to physical and psychological distress, requiring surgical treatment for severe AIS. Exercise has been proposed as a conservative treatment or postoperative rehabilitation. Yet, the effectiveness of preoperative exercise and prehabilitation in improving surgical outcomes remains unclear.

This systematic review evaluates the effectiveness of preoperative exercise and prehabilitation in improving surgical outcomes and analyzes which outcomes showed significant improvement.

Six major databases were searched for studies published before June 2025. Studies recruiting AIS patients aged under 18 undergoing surgeries and performing preoperative exercise or ERAS protocols involving preoperative exercise are included. Outcomes include pain level, hospitalization time, postoperative complications, curve correction, spine flexibility, cardiopulmonary function, re-admission and quality of life.

Nine studies with 574 patients were included, comprising 329 patients as exercise-intervention group and 245 patients receiving no intervention or other preoperative interventions. The average age was 14.86 ± 2.78 [CI: 14.63, 15.09] and mean Cobb angle was 65.59°±13.47° [CI: 64.49, 66.69]. The exercise-intervention group showed lower postoperative VAS scores than control. The average length of hospital stay was 2.5 days shorter in the exercise group compared to control (4.15 [CI: 4.04, 4.26] vs. 6.65 [CI: 6.29, 7.01]). The exercise group also demonstrated fewer postoperative complications (Rate: 5.2% vs. 18.5%), improvement in spine flexibility (from 0.39 to 0.66), better cardiopulmonary function and higher quality of life. The mean rate of re-admission of exercise-intervention groups is 0.9%.

Preoperative exercise has been shown to improve postoperative pain, length of stay, complications, cardiopulmonary recovery, and quality of life. Although its effect on objective surgical correction outcomes remains uncertain, incorporating preoperative exercise into AIS surgical care may enhance recovery experience and functional outcomes. However, given the significant heterogeneity among studies, further research and clinical trials are needed to standardize implementation protocols and outcome measures, as well as to conduct subgroup analysis based on baseline severity and spinal flexibility.