Objectives <p>Enhanced Recovery After Surgery (ERAS) protocols aim to improve surgical outcomes, by mitigating postoperative stress through multimodal perioperative care. In spinal surgery, such protocols may reduce pain, hospital length of stay (LoS), and opioid use. However, prior retrospective studies often suffer from heterogeneity in patient populations and surgical procedures, limiting interpretability. This trial was designed to evaluate the impact of an ERAS protocol on short-term clinical outcomes and LoS in patients undergoing elective single-level lumbar arthrodesis for degenerative spondylolisthesis. </p> Methods <p>This single center randomized controlled trial included 42 patients allocated to ERAS (n = 18) or standard care (n = 24). The ERAS protocol included preoperative Gabapentin administration, intraoperative multimodal analgesia, same-day physiotherapy, and early nutritional intake. The primary outcome was LoS. Secondary outcomes included pain at discharge, opioid consumption, postoperative complications, and unplanned readmissions occurring within 11 days after discharge. Data were analyzed using univariate statistical tests and multivariable regression models.</p> Results <p>Median LoS was 3 days in both groups (p = .685). Pain scores at discharge were lower in the ERAS group (mean 2.5 ± 1.5) versus control (3.1 ± 2.2), though not statistically significant (p = .079). Multivariate analysis identified World Health Organization (WHO) pain medication level as a significant predictor of LoS (p = .025), and postoperative nausea and vomiting (PONV) as a predictor of discharge pain (p = .031). No significant differences were observed in complications or readmission rates. </p> Conclusion <p>ERAS protocol did not reduce LoS in single level lumbar arthrodesis. Discharge pain and PONV had a significant impact on recovery, suggesting that these could be potential focal points for protocol refinement. Larger, procedure-specific trials with long-term follow-up are warranted.</p>