Spinal fracture surgery has advanced with new tools, biologics and minimally invasive techniques, but recovery remains one of the most important determinants of patient outcomes. To improve healing and reduce complications, many hospitals are adopting Enhanced Recovery After Surgery (ERAS) protocols. Dr. Larry Davidson, a leader in minimally invasive spinal surgery, has emphasized that these structured pathways are particularly valuable in fracture care, where patient safety, pain control and early mobility are critical.
ERAS protocols break recovery into evidence-based steps, and ERAS protocols optimize everything from preoperative preparation to post-operative rehabilitation. Applied specifically to spinal fractures, they reduce risks, shorten hospital stays and improve quality of life for patients navigating complex recoveries.
The Foundation of ERAS
ERAS protocols were first developed in general and orthopedic surgery, but have since been adapted across many specialties. Their foundation lies in standardizing care around best practices, while tailoring steps to patient needs. In spinal fracture care, this includes strategies for pre-surgical optimization, multimodal pain management, early mobilization and coordinated rehabilitation.
The goal is to minimize surgical stress, reduce complications and accelerate the return to independence. For fracture patients, whose mobility and stability are already compromised, these structured pathways provide a safer, more predictable course of recovery.
Preoperative Optimization
The ERAS journey starts well before surgery. Preoperative preparation focuses on improving a patient’s overall health, to support better surgical outcomes. Nutritional assessment helps provide the resources needed for healing, while quitting smoking and managing blood sugar reduce the risk of complications.
Education is also a key part of this phase. Patients learn what to expect during and after surgery, which helps lower anxiety and encourages adherence to post-operative protocols. With this preparation, patients enter surgery with confidence and take a more active role in their recovery.
Multimodal Pain Management
Effective pain control is one of the cornerstones of ERAS. Rather than relying solely on opioids, ERAS protocols use multimodal pain strategies that combine medications, nerve blocks and non-pharmacological therapies. This approach reduces opioid dependency, while providing more consistent relief.
For spinal fracture patients, nerve blocks and local anesthetics may be used during surgery to provide immediate post-operative comfort. NSAIDs, acetaminophen and adjuvant drugs address inflammation and nerve pain, while physical therapy supports long-term pain reduction through movement.
Minimizing Surgical Stress
ERAS protocols also aim to minimize surgical stress. Techniques, such as minimally invasive approaches, reduced blood loss strategies and shorter anesthesia times, all support faster recovery. Intraoperative monitoring and imaging improve accuracy, reducing the likelihood of complications that could prolong hospitalization. By limiting trauma to the body, these methods shorten the transition from surgery to rehabilitation. Patients benefit not only from smoother immediate recovery, but from stronger long-term outcomes.
Early Mobilization
Early mobilization is perhaps the most visible feature of ERAS in spinal fracture care. Patients are encouraged to walk or move with assistance, as soon as possible after surgery. It reduces the risk of blood clots, pneumonia and muscle deconditioning, while also improving mental well-being. Physical therapists play a central role, teaching safe movements and building confidence. Even small steps early in recovery can lead to faster gains in strength and independence.
Dr. Larry Davidson states, “Spinal cord injury surgery is about more than fixing bones; it’s about giving patients the best chance at reclaiming their lives.” His perspective highlights how ERAS protocols embody this philosophy, by making sure that recovery is not limited to structural repair, but extends into restoring confidence, mobility and quality of life.
Nutrition and Hydration
Post-operative nutrition is carefully managed under ERAS protocols. Rather than delaying food intake, patients are often encouraged to resume oral nutrition shortly after surgery. Balanced meals support bone healing and muscle recovery, while adequate hydration maintains circulation and prevents complications. Nutritional supplements, including protein and vitamin D, are often integrated to support bone strength and immune function. While sometimes overlooked, these details significantly influence long-term healing.
Rehabilitation Integration
Rehabilitation is not delayed until discharge. Under ERAS, therapy begins in the hospital and continues seamlessly into outpatient care. Physical and occupational therapists design programs tailored to each patient’s goals, whether they involve returning to daily activities, work or sports. By incorporating rehabilitation early and consistently, ERAS protocols help patients maintain momentum. This approach minimizes setbacks, and enhances overall satisfaction with the recovery process.
Reducing Hospital Stays
One of the measurable impacts of ERAS is shorter hospital stays. Patients who follow structured recovery protocols experience fewer complications and are discharged earlier. It not only improves patient experience but also reduces healthcare costs. For fracture patients, earlier discharge means a faster return to familiar environments, which supports psychological recovery, as well. With proper follow-up, this transition remains safe, while promoting independence.
Athletes and ERAS Benefits
Athletes recovering from spinal fractures can gain significant advantages from ERAS protocols. Their focus often extends beyond healing, to returning to peak performance. ERAS’s structured, proactive approach complements athletic discipline, offering a clear roadmap for recovery. With nutritional support, early mobilization and advanced pain management, athletes can resume conditioning sooner. Adapting ERAS for athletic patients helps balance safety with performance goals.
Training Teams in ERAS Implementation
Successful ERAS programs rely on collaboration. Surgeons, anesthesiologists, nurses and therapists all contribute to delivering coordinated care. Training helps team members understand their roles and communicate effectively with patients. Mentorship also plays a key role, guiding younger surgeons and staff in applying ERAS principles in practice. Consistent teamwork across the care team is essential for effective protocols.
Patients as Active Partners
Patients are active participants in ERAS, and they play a central role in its success. Education about the protocols helps them understand the importance of early mobilization, nutrition and therapy. When patients engage fully, they are more likely to follow guidance and achieve better outcomes. This shared responsibility builds trust between patient and provider. Those who view themselves as partners in recovery often experience smoother healing and greater confidence in their care.
The future of ERAS in spinal fracture care will likely include greater personalization. AI-driven analytics may help customize pain management or mobilization plans for each patient. Wearable devices could track activity levels and provide feedback to care teams in real time. These advances will further refine protocols, making recovery more efficient and tailored to individual needs. For patients, it promises faster healing and fewer setbacks.
Enhanced Recovery After Surgery (ERAS) protocols are reshaping spinal fracture care by combining multimodal pain management, early mobilization, nutrition and rehabilitation into structured pathways. These evidence-based practices reduce complications, shorten hospital stays and improve long-term outcomes. The experience underscores the value of ERAS in transforming recovery from a passive process into an active, patient-centered journey. A future in which spinal fracture surgery is not only about stabilization, but about empowering patients to heal with strength and confidence.
