Prehabilitation in Spine Surgery and Joint Arthroplasty

This chapter explores the concept of prehabilitation in spine surgery and joint arthroplasty, tracing its evolution from injury prevention to a proactive approach for improving surgical outcomes. Prehabilitation has gained prominence in recent years, aligning with the shift towards value-based care and enhanced recovery after surgery (ERAS) protocols. The chapter discusses the significance of prehabilitation in addressing the global burden of musculoskeletal disorders, particularly low back pain and joint disease. It outlines the continuum of care, from conservative treatments to the decision for surgery, emphasizing shared decision-making and patient education. Key components of prehabilitation are examined, including nutritional optimization, weight management, exercise interventions, pain management, and psychoeducative approaches. The chapter highlights the importance of addressing modifiable risk factors such as obesity, smoking, and uncontrolled diabetes. It also discusses the role of preoperative risk screening, including frailty assessments. Specific prehabilitation strategies for spine surgery and joint arthroplasty are explored, including aerobic capacity interventions, resistance training, and pain management techniques. The chapter also addresses the challenges of opioid use in the preoperative period. It discusses alternative pain management strategies within the unique risk profile when anticipating joint replacement and spine surgeries. Overall, this chapter provides a comprehensive overview of prehabilitation in orthopedic surgery, emphasizing its potential to improve patient outcomes, reduce complications, and enhance the overall surgical experience.