Enhanced Recovery After Surgery (ERAS) in Spine Surgery: A Systematic Review and Meta-Analysis of Spinal Surgery Sub – Specialities, Interventions and Efficacy

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Study Design Systematic Review. Objectives Enhanced Recovery After Surgery (ERAS) is a widely acknowledged approach for improving surgical outcomes. This review aims at analyzing the characteristics of study populations, interventions and outcomes in spine patients. Methods Embase and Ovid were searched from inception until March 2025. We followed PRISMA guidelines. Study quality and risk of bias were assessed. In addition to a narrative synthesis of the evidence, a meta-analysis of RCTs evaluating length of stay (LOS) for a lumbar spine population was conducted. This review was registered prospectively on PROSPERO (No. CRD42025638293). Results 1431 records were identified, from which 81 studies were included. Reports of ERAS predominantly exist for degenerative spine pathologies (n = 35/81, 43.2%) and spinal deformities (n = 29/81, 35.8%). Most studied interventions were postoperative analgesia, early mobilisation (both n = 61/81, 75.3%) and patient education (n = 60, 74.1%). The most frequently used outcome measures were LOS (n = 65/81, 92.9%) and complication rates (n = 40/81, 49.4%). The overall median complication rate for ERAS patients was found to be lower (8.8% vs 15.6%). There was a statistically non-significant tendency for ERAS shortening LOS for 1 day in lumbar spine patients [95%CI -2.77, 0.71; P = 0.25]. Conclusions ERAS in spine surgery appears to be effective in terms of reducing LOS and complication rates. Further efforts at refining pain management and targeted disease-specific interventions are required. Whether ERAS interventions applied to individuals with significant neurological impairment and/or medical frailty, can influence surgical outcomes needs to be further studied.

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