Prehabilitation Before Spine Surgery

Prehabilitation before spine surgery typically combines several strands: guided exercise and physiotherapy to build strength and fitness; education about the operation and the recovery, so people know what to expect and are less anxious; and optimisation of general health factors — which is where it links to bone health, weight, smoking cessation and, where relevant, psychological preparation. The exercise and education components are led by physiotherapists; the wider optimisation involves other members of the team. The common aim is to arrive at the operation as fit, informed and prepared as possible.

I value prehabilitation for reasons that go beyond any single measurable outcome: a person who understands their operation and recovery, who is as fit as they can be, and whose general health has been optimised, is easier to look after and, in my experience, recovers more confidently. I also think it is important to be honest about the evidence, which is genuinely mixed. Some studies and reviews show that prehabilitation improves early recovery, function and, in the wider surgical literature, reduces complications and length of stay; others, including a systematic review specific to lumbar spine surgery, have found that current prehabilitation programmes do not clearly improve the postoperative outcomes measured. So I present it not as a guaranteed boost to the surgical result, but as sensible, low-risk preparation that helps people go into surgery in the best possible shape — while being candid that the evidence base is still evolving.

Where I am planning surgery, prehabilitation is arranged with the physiotherapy team and, where relevant, the services that address bone health, smoking and weight. The period before an operation is a valuable window to build fitness and address modifiable risks, and to prepare mentally for the recovery ahead. The specifics of the exercise programme belong to the physiotherapist; the wider optimisation is a team effort; and I coordinate this around the timing of surgery.

The evidence is genuinely mixed, and I present it that way. Randomised trials such as Nielsen's prehabilitation-and-early-rehabilitation study and the PREPARE trial, and several systematic reviews, have examined presurgical exercise and education before spine surgery, with some showing benefits in recovery and function and others — including a spine-specific systematic review and meta-analysis — finding no clear improvement in the measured postoperative outcomes. In the broader orthopaedic literature, a large meta-analysis found prehabilitation improved some functional and economic outcomes. Taken together, this supports prehabilitation as reasonable, low-risk preparation rather than a proven transformer of surgical results.

Prehabilitation is a period of preparation in the weeks before surgery, guided by physiotherapy and the wider team, aimed at arriving fit, informed and optimised. It complements — but does not replace — the operation itself and the rehabilitation that follows. As always, the plan is individualised and coordinated around the timing of surgery.

• —Nielsen PR, et al. Prehabilitation and early rehabilitation after spinal surgery: randomised clinical trial. Clin Rehabil 2010. (PMID 20103575)
• —Lindbäck Y, et al. PREPARE: presurgery physiotherapy for degenerative lumbar spine disorder: RCT. Spine J 2018. (PMID 29253630)
• —Janssen ERC, et al. Current prehabilitation programs do not improve postoperative outcomes of lumbar spine surgery: systematic review with meta-analysis. J Orthop Sports Phys Ther 2021. (PMID 33356804)
• —Marchand AA, et al. Effectiveness of prehabilitation in functional and economic outcomes following spinal surgery: systematic review. Int J Spine Surg 2018. (PMID 30050730)
• —Punnoose A, et al. Prehabilitation for patients undergoing orthopedic surgery: systematic review and meta-analysis. JAMA Netw Open 2023. (PMID 37014643)