Abstract
There is a growing need for effective perioperative strategies to mitigate the physiological and psychosocial impact of spinal surgery on the patient. Not only is spinal pathology one of the most common and disabling conditions in the world, a growing elderly and more infirm population, along with health economic pressures and an evolving opioid epidemic, pose significant challenges to its treatment. Enhanced recovery after surgery (ERAS) represented a paradigm shift when it was first conceived in the 1990s in the field of colorectal surgery, and has over the past few years also been adopted in spinal surgery. Beyond the technical aspects of spinal surgery, ERAS incorporates multidisciplinary, evidence-based interventions into the pre-, intra-, and postoperative phases of care, with continual quality improvement via an iterative process. Key ERAS elements in spinal surgery include preoperative education and optimization, intraoperative maintenance of homeostatic mechanisms, and application of advanced anesthetic and minimally-invasive surgical techniques, multimodal opioid-sparing analgesic regimens, standardized perioperative protocols including prompt mobilization, and early disposition planning and follow-up. There is emerging evidence supporting the efficacy of ERAS in spinal surgery, including improved pain control, earlier mobilization, reduced narcotic consumption, reduced length of stay, reduced hospital costs, and high rates of patient satisfaction, without increasing complications or readmissions.