Clinical impact of Enhanced Recovery After Spinal Surgery Protocols on One-Level Lumbar Arthrodesis: Results from a Single-Center Randomized Controlled Trial

BACKGROUND AND OBJECTIVES: Enhanced Recovery After Surgery (ERAS) protocols aim to improve surgical outcomes, by mitigating postoperative stress through multimodal perioperative care. In spinal surgery, such protocols—termed Enhanced Recovery After Spine Surgery (ERASS)—may reduce pain, hospital length of stay (LoS), and opioid use. However, prior retrospective studies often suffer from heterogeneity in patient populations and surgical procedures, limiting interpretability. This trial was designed to evaluate the impact of an ERASS protocol on short-term clinical outcomes and LoS in patients undergoing elective single-level lumbar arthrodesis for degenerative spondylolisthesis. METHODS: This single-center, randomized controlled trial included 42 patients allocated to ERASS (n=18) or standard care (n=24). The ERASS protocol included preoperative Gabapentin, early offering of dinner, intraoperative multimodal analgesia, and same-day physiotherapy. Primary outcome was LoS; secondary outcomes included pain at discharge, opioid use, complications, and readmissions. Data were analyzed using univariate statistical tests and multivariable regression models. RESULTS: Median LoS was 3 days in both groups (p=0.685). Pain scores at discharge were lower in the ERASS group (mean 2.5 ± 1.5) versus control (3.1 ± 2.2), though not statistically significant (p=0.079). Multivariate analysis identified World Health Organization (WHO) pain medication level as a significant predictor of LoS (p=0.025), and postoperative nausea and vomiting (PONV) as a predictor of discharge pain (p=0.031). No significant differences were observed in complications or readmission rates. CONCLUSION: While ERASS did not reduce LoS, it trended toward better pain outcomes. Discharge pain and PONV significantly impacted recovery, suggesting these as potential focal points for protocol refinement. Larger, procedure-specific trials with long-term follow-up are warranted.