Can Prehabilitation Save Older Spine Surgery Patients?

Historically, spinal fusion surgery carries high risk for older individuals due to diminished physiological reserve. Recently, researchers evaluated whether multimodal prehabilitation combined with Enhanced Recovery After Surgery (ERAS) improves surgical safety. Therefore, this randomized clinical trial targeted adults aged 75 or older to observe 90-day postoperative complications.

The PRACTICE Trial Design

Specifically, this multicenter, open-label, randomized controlled trial took place across three tertiary hospitals in China. Between May 2024 and May 2025, investigators recruited patients undergoing elective spinal fusion. Subsequently, they assigned 164 participants to either a 4-week prehabilitation program plus ERAS (PREERAS) or ERAS alone. The intervention integrated supervised exercises, nutritional support, and psychological counseling. Ultimately, 159 patients completed the final analysis, providing robust comparative data.

Benefits of Multimodal Prehabilitation

Remarkably, the study demonstrated a significant reduction in postoperative complications. In the PREERAS group, only 74.7% of patients experienced at least one complication. In contrast, 91.2% of patients in the ERAS-only group suffered complications. Consequently, the PREERAS group achieved an 18% absolute risk reduction. Furthermore, statistical analysis confirmed a risk ratio of 0.80, proving the clinical efficacy of this approach. These findings highlight how pre-surgical optimization protects vulnerable geriatric patients.

Practical Implementation and Limitations

However, healthcare providers must carefully consider some limitations before full implementation. First, clinicians and patients could not remain blinded during the trial. Second, Chinese healthcare systems typically involve longer hospital stays, which might limit generalizability to Western settings. Nevertheless, the physical benefits of Vivifrail-based exercises remain highly relevant globally. Thus, Indian spinal centers should evaluate their resource requirements to successfully adopt these prehabilitation services.

Frequently Asked Questions

Q1: What exactly did the multimodal prehabilitation program entail?

The four-week prehabilitation program integrated several therapeutic components. Specifically, it combined Vivifrail-based physical exercises, personalized nutritional support, and structured psychological coaching.

Q2: How did the PREERAS protocol affect postoperative complication rates?

Remarkably, the prehabilitation group experienced significantly fewer complications than the control group. Indeed, patients in the prehabilitation group achieved an 18% absolute reduction in 90-day complications.

Q3: Is this prehabilitation program feasible for Indian clinical practice?

Yes, although clinical teams must carefully assess their local resources first. While the protocol requires multidisciplinary coordination, the physical and nutritional interventions remain highly adaptable to Indian hospitals.

References

1. Wang S et al. Multimodal Prehabilitation for Older Adults Undergoing Spinal Fusion : A Randomized Clinical Trial. Ann Intern Med. 2026 Jun 16. doi: 10.7326/ANNALS-25-05205. PMID: 42296500.
2. Wang S et al. Multimodal prehabilitation combined with perioperative enhanced recovery after surgery care for older patients undergoing spinal fusion surgery in China: protocol for a multicentre randomised controlled trial (PRACTICE trial). BMJ Open. 2024 Jun 25;14(6):e088339. doi: 10.1136/bmjopen-2024-088339.