Degenerative spine disease increases in prevalence and may become debilitating as people age. Complex spine surgery may offer relief but becomes riskier with age. Efforts to lessen the physiological impact of surgery through minimally invasive techniques and enhanced recovery programs mitigate risk only after the decision for surgery. Frailty assessments outperform traditional tools of perioperative risk stratification. The extent of frailty predicts complications after spine surgery such as reoperation for infection and 30-day mortality, as well as elements of social cost such as hospital length of stay and discharge to an advanced care facility. Symptoms of spine disease overlap with phenotypic markers of frailty; therefore, different frailty assessment tools may perform differently in patients with degenerative spine disease. Beyond frailty, however, cognitive decline and psychosocial isolation may interact with frailty and affect achievable surgical outcomes. Prehabilitation, which has reduced perioperative risk in colorectal and cardiac surgery, may benefit potential complex spine surgery patients. Typical prehabilitation includes physical exercise, nutrition supplementation, and behavioral measures that may offer symptomatic relief even in the absence of surgery. Nonetheless, the data on the efficacy of prehabilitation for spine surgery remains sparse and barriers to prehabilitation are poorly defined. This narrative review concludes that a frailty assessment—potentially supplemented by an assessment of cognition and psychosocial resources—should be part of shared decision-making for patients considering complex spine surgery. Such an assessment may suffice to prompt interventions that form a prehabilitation program. Formal prehabilitation programs will require further study to better define their place in complex spine care.

退行性脊柱疾病的患病率增加，并可能随着人们年龄的增长而变得虚弱。复杂的脊柱手术可能会缓解疼痛，但随着年龄的增长风险会增加。只有在决定手术后，通过微创技术和增强恢复计划来减轻手术对生理影响的努力才能降低风险。虚弱评估优于传统的围手术期风险分层工具。虚弱程度可预测脊柱手术后的并发症，例如因感染再次手术和 30 天死亡率，以及社会成本要素，例如住院时间和出院到高级护理机构的时间。脊柱疾病的症状与虚弱表型标志重叠；因此，不同的衰弱评估工具对退行性脊柱疾病患者的表现可能不同。除了虚弱，然而，认知能力下降和社会心理孤立可能与虚弱相互作用并影响可实现的手术结果。预康复降低了结直肠和心脏手术的围手术期风险，可能使潜在的复杂脊柱手术患者受益。典型的预康复包括体育锻炼、营养补充和行为措施，即使在没有手术的情况下也可以缓解症状。尽管如此，有关脊柱手术预康复疗效的数据仍然很少，而且预康复的障碍也不清楚。这篇叙述性综述得出的结论是，对于考虑进行复杂脊柱手术的患者，虚弱评估（可能辅以认知和社会心理资源评估）应该成为共同决策的一部分。这样的评估可能足以促进形成预康复计划的干预。正式的预康复计划将需要进一步研究，以更好地确定其在复杂脊柱护理中的地位。