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Preoperative rehabilitation optimization for spinal surgery: a narrative review of assessment, interventions, and feasibility

  • Review Article
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Abstract

Purpose

Postoperative physical therapy (PT) is a cornerstone of orthopedic and musculoskeletal rehabilitation, proven to provide various positive clinical benefits. However, there is a paucity of literature evaluating the utility of preoperative rehabilitation specific to spine surgery. Thus, this review article aims to provide an overview of previously published studies discussing the efficacy of preoperative rehabilitation programs and its role in spinal surgery. Special emphasis was given to preoperative frailty assessments, physical performance tests, interventional strategies, feasibility, and future directions.

Methods

We performed a literature review using PubMed, Google Scholar, EMBASE, and PubMed Central (PMC) using directed search terms. Articles that examined preoperative rehabilitation in adult spine surgery were compiled for this review.

Summary of key finding

Prehabilitation programs focused on exercise, flexibility, and behavioral modifications have been shown to significantly improve pain levels and functional strength assessments in patients undergoing elective spine surgery. In addition, studies suggest that these programs may also decrease hospital stays, return to work time, and overall direct health care expenditure costs. Screening tools such as the FRAIL scale can be used to assess frailty while physical function tests like the timed-up-and go (TUGT), 5 repetition sit-to-stand test (5R-STST), and hand grip strength (HGS) can help identify patients who would most benefit from prehabilitation.

Conclusions

This review illustrates that prehabilitation programs have the potential to increase quality of life, improve physical function and activity levels, and decrease pain, hospital stays, return to work time, and overall direct costs. However, there is a paucity of literature in this field that requires further study and investigation.

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Data availability

The data used to complete this review article was accessed through publicly accessible biomedical databases.

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Funding

No funding was received for the composition of this manuscript.

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Authors and Affiliations

  1. The Och Spine Hospital, New York-Presbyterian/Columbia University Irving Medical Center, 5141 Broadway, 3 Field West, New York, NY, 10034, USA

    Justin L. Reyes, Josephine R. Coury, Alexandra Dionne, Roy Miller, Prerana Katiyar, Joseph M. Lombardi & Zeeshan M. Sardar

  2. Conservative Care for Spine and Scoliosis/ Columbia University Irving Medical Center, New York, NY, USA

    Abigail Smul & Prachi Bakarania

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  1. Justin L. Reyes
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Contributions

Justin L. Reyes, MS; Josephine R. Coury, MD; Alexandra Dionne, BS; Roy Miller, MS; Prerana Katiyar, BS Conceptualization, data collection, writing/manuscript preparation, approval of final manuscript and accountable for the work presented. Abigail Smul, DPT; Prachi Bakarania, DPT; Joseph M. Lombardi, MD; Zeeshan M. Sardar MD Conceptualization, data collection, critical review, approval of final manuscript and accountable for the work presented.

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Conflict of interest

Justin L. Reyes, Alexandra Dionne, Roy Miller, Prerana Katiyar, Josephine Coury, Abigail Smul, and Prachi Bakarania do not have any financial disclosures. Joseph M Lombardi has received consulting fees from Medtronic and Stryker. Zeeshan Sardar has received consulting fees from Medtronic.

Ethical approval

No research was conducted on human subjects in the composition of this review article. Ethical approval was not sought after as this article is a compendium of original studies that have undergone peer-review and had obtained ethical approval for research.

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Reyes, J.L., Coury, J.R., Dionne, A. et al. Preoperative rehabilitation optimization for spinal surgery: a narrative review of assessment, interventions, and feasibility. Spine Deform (2024). https://doi.org/10.1007/s43390-024-00893-0

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