Can Physical Prehabilitation Reverse Frailty in Elderly Patients Before Spine Surgery? A Case Report

Frailty is a syndrome that results from age-associated decline of physiological function and decreased response to stressors. It has been associated with postoperative adverse events in the spine surgery population. Evaluation of frailty in older adults undergoing surgery is becoming increasingly incorporated in the preoperative evaluation due to the growing number of aging patients requiring surgery. However, which optimization strategies should be incorporated into the preoperative plan to improve the patient's overall health and quality of life is unclear. Physical prehabilitation has been evaluated in the spine surgery population. However, prehabilitation before spine surgery has mainly focused on cognitive behavioral therapy and physical exercise to alleviate pain. None of the current studies for prehabilitation in spine surgery addressed the role of physical prehabilitation in reversing frailty in older adults. This case report presents the impact of physical prehabilitation on frailty indices and immediate postoperative outcomes in frail spine surgery patients. We present two patients who participated in a physical prehabilitation program for frail older adults requiring spine surgery. Both patients had significant improvement in their frailty, functional capacity, and overall quality of life, as indicated subjectively by the patients. One patient opted out of surgery due to overall improved functional capacity. In this report, we also highlight the impact of physical prehabilitation on the possibility of reversing frailty. Frailty is a well-known risk factor for postoperative adverse events after spine surgery, and whether to modify this risk factor to improve outcomes is still a question that requires future well-designed research studies. This case report shows that physical prehabilitation is a feasible intervention to reverse or prevent the worsening of frailty in spine surgery patients.