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不断增加，并且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症状，但随着年龄的增长，风险会增加。通过微创技术和强化康复计划来减轻手术对生理影响的努力只有在决定手术后才能降低风险。衰弱评估优于围手术期风险分层的传统工具。虚弱程度可以预测脊柱手术后的并发症，例如感染再次手术和 30 天死亡率，以及社会成本因素，例如住院时间和出院到高级护理机构。脊柱疾病的症状与虚弱的表型标志重叠；因此，不同的衰弱评估工具对于退行性脊柱疾病患者的表现可能不同。然而，除了虚弱之外，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。预康复可以降低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。典型的康复治疗包括体育锻炼、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，关于脊柱手术预康复效果的数据仍然很少，并且预康复的障碍也不清楚。这篇叙述性综述的结论是，虚弱评估——可能辅以认知和社会心理资源评估——应该成为考虑复杂脊柱手术的患者共同决策的一部分。这样的评估可能足以促进形成预康复计划的干预措施。 正式的康复计划需要进一步研究，以更好地确定其在复杂脊柱护理中的地位。