Enhanced Recovery After Surgery with Integrative Care

Enhanced Recovery After Surgery (ERAS) Programs for Spine Surgery: Key Components and Innovative Approaches to Better Outcomes

Spine surgery helps many people experience pain relief and improve their daily lives. Modern programs called Enhanced Recovery After Surgery (ERAS), also known as Enhanced Surgical Recovery (ESR), make recovery faster and easier. These programs use a team approach with proven steps before, during, and after surgery. They focus on reducing the need for strong pain drugs like opioids, cutting down time in the hospital, and lowering the chance of going back to the hospital. Adding integrative care from chiropractors and nurse practitioners, along with new tools such as virtual reality (VR), can make these programs even better.

ERAS programs started in other types of surgery but now work well for spine procedures, such as lumbar fusion or cervical operations. Patients in these programs often feel better sooner and have fewer problems.

Core Components of ERAS for Spine Surgery

The most effective ERAS programs include steps in three main phases: before surgery, during surgery, and after surgery. These steps work together to help the body heal with less stress.

Preoperative Phase: Preparing the Body and Mind

Good preparation sets the stage for smooth recovery.

• Patient Education and Counseling: Patients learn what to expect, including pain management and activity goals. This reduces worry and helps them follow the plan (American Association of Nurse Anesthetists, n.d.).
• Nutrition Optimization: Eating well before surgery, including special drinks with carbs, builds strength. Fixing poor nutrition or low blood levels prevents delays in healing (Elsarrag et al., 2022).
• Multimodal Pain Planning: Doctors plan to use several non-opioid drugs, like acetaminophen or gabapentin, to start pain control early (Wainwright et al., 2023).

These steps help patients arrive stronger and more ready.

Intraoperative Phase: Gentle Techniques During Surgery

During the operation, the focus is on reducing harm to the body.

• Minimally invasive methods when possible.
• Careful fluid management.
• Drugs such as ketamine or lidocaine are used to manage pain without the use of heavy opioids (Debono et al., 2023).

Postoperative Phase: Quick Return to Normal Activities

This phase drives the most significant improvements.

• Early Mobilization: Getting up and walking soon after surgery, often the same day, builds strength and helps prevent complications such as blood clots (Wainwright et al., 2023).
• Multimodal Pain Management: Combining drugs like NSAIDs, muscle relaxers, and low-dose opioids controls pain with fewer side effects. This significantly reduces opioid use (Dietz et al., 2023; HCA Healthcare, 2022).
• Early Eating and Drinking: Starting normal food quickly helps the gut recover and provides energy (American Association of Nurse Anesthetists, n.d.).

These components lead to real benefits. In one large program, patients stayed in the hospital 2.1 days less and used up to 44% fewer opioids (HCA Healthcare, 2022). Complications drop, and readmissions decrease by up to 54% in some cases.

Benefits: Less Opioids, Shorter Stays, and Fewer Readmissions

ERAS programs change outcomes for spine surgery patients.

• Reduced Opioid Use: Multimodal plans lower in-hospital opioid needs by 30-50% or more. One study showed that much lower doses were associated with lower pain scores (Dietz et al., 2023).
• Shorter Hospital Stays: Patients often go home 1-3 days earlier. Early walking and effective pain control make this possible (Wainwright et al., 2023; HCA Healthcare, 2022).
• Lower Readmission Rates: Fewer complications, such as infections or delirium, mean a lower chance of returning to the hospital. Rates can drop significantly (HCA Healthcare, 2022).

These results come from following many steps together, not just one.

Role of Integrative Chiropractic Care in ERAS

Chiropractic care fits well into ERAS by offering non-drug ways to manage pain and improve movement. Dr. Alexander Jimenez, DC, APRN, FNP-BC, a chiropractor and family nurse practitioner with over 30 years of experience, stresses holistic approaches in recovery. His work in integrative health includes nutrition and rehabilitation to support post-surgical healing (Jimenez, n.d.).

Chiropractic helps in these ways:

• Prehabilitation: Before surgery, adjustments improve posture and mobility. This prepares the body for better outcomes.
• Postoperative Support: After healing begins (often weeks or months later, with the surgeon’s approval), gentle techniques reduce scar tissue, ease muscle tension, and restore range of motion (Active Health Center, n.d.; New York City Spine, n.d.).
• Non-Opioid Pain Relief: Soft tissue work and adjustments lower pain without drugs. Studies show adding chiropractic to rehab cuts pain scores by 30% more than therapy alone (Active Health Center, n.d.).

Patients recover mobility faster and avoid long-term stiffness. Chiropractic complements ERAS by focusing on the whole body.

How Nurse Practitioners Strengthen ERAS Programs

Nurse practitioners (NPs) play a key role in making ERAS work. They coordinate care across the team.

• Patient Education and Monitoring: NPs teach patients about the plan and evaluate progress daily.
• Medication Management: They handle non-opioid drugs and adjust as needed.
• Team Coordination: NPs bridge surgeons, nurses, and therapists to keep everyone on track (Zhang et al., 2025; Wainwright et al., 2022).

In spine programs, NPs help with early mobilization and nutrition. Their involvement leads to better adherence and better outcomes, such as shorter stays (American Association of Nurse Anesthetists, n.d.).

Dr. Jimenez, with his dual credentials as a DC and FNP-BC, demonstrates how NPs can blend advanced nursing with integrative care to provide comprehensive patient support.

Using Virtual Reality (VR) for Better Strength and Recovery

New technology like VR adds excitement to recovery exercises.

VR creates enjoyable, guided sessions that feel like games.

• Pain Reduction: Immersive environments distract from pain and reduce its intensity (Techet al., 2024).
• Improved Strength and Mobility: VR provides feedback to guide physical therapy. Patients move more and build strength better.
• Engagement and Motivation: Fun activities make people stick to exercises longer. This boosts mental focus and speeds healing (Lohre et al., 2023; Recovr Study, 2025).

For spine patients, VR helps with balance, walking, and core strength at home or in therapy. Early studies show faster functional gains and reduced pain perception. Adding VR to ERAS makes rehab engaging and effective.

Building a Holistic ERAS Approach

The best ERAS programs combine traditional steps with integrative care and technology.

• Multimodal pain control.
• Early activity.
• Team support from NPs and chiropractors.
• Tools like VR.

This creates faster, safer recovery with less reliance on opioids.

Patients feel in control and heal stronger.

Conclusion

ERAS programs transform spine surgery recovery by focusing on the whole patient. Key parts like education, nutrition, early movement, and smart pain management deliver clear wins: fewer opioids, quicker discharges, and lower readmissions. Adding chiropractic care provides natural pain relief and better mobility. NPs ensure smooth coordination. VR makes therapy fun and effective for strength building.

As experts like Dr. Alexander Jimenez show, blending these approaches leads to the best healing.

References

Active Health Center. (n.d.). Rehabilitation after surgery: Integrating chiropractic care into recovery. https://activehealthcenter.com/rehabilitation-after-surgery-integrating-chiropractic-care-into-recovery/

American Association of Nurse Anesthetists. (n.d.). Enhanced recovery after surgery. https://www.aana.com/practice/clinical-practice/clinical-practice-resources/enhanced-recovery-after-surgery/

Debono, B., et al. (2023). Enhanced recovery after surgery (ERAS) protocols for spine surgery – review of literature. Polish Annals of Medicine. https://pmc.ncbi.nlm.nih.gov/articles/PMC10156499/

Dietz, N., et al. (2023). Adoption of enhanced surgical recovery (ESR) protocol for lumbar fusion decreases in-hospital postoperative opioid consumption. Global Spine Journal. https://pmc.ncbi.nlm.nih.gov/articles/PMC10189339/

Elsarrag, M., et al. (2022). Enhanced recovery after surgery (ERAS) protocol in spine surgery. Journal of Orthopaedics and Traumatology. https://pmc.ncbi.nlm.nih.gov/articles/PMC9293758/

HCA Healthcare. (2022, December 13). HCA Healthcare’s innovative approach to surgical recovery promotes better outcomes, decreased opioid usage and faster recovery times for patients. https://hcahealthcaretoday.com/2022/12/13/hca-healthcares-innovative-approach-to-surgical-recovery-promotes-better-outcomes-decreased-opioid-usage-and-faster-recovery-times-for-patients/

Jimenez, A. (n.d.). Dr. Alexander Jimenez. https://dralexjimenez.com/

Lohre, R., et al. (2023). Immersive virtual reality in orthopaedics—a narrative review. International Orthopaedics. https://link.springer.com/article/10.1007/s00264-023-05911-w

New York City Spine. (n.d.). How a chiropractor can aid spinal fusion recovery. https://newyorkcityspine.com/how-a-chiropractor-can-aid-spinal-fusion-recovery/

Recovr Study. (2025). Recover after injury or surgery to the brain and spinal cord with virtual reality. Journal of NeuroEngineering and Rehabilitation. https://jneuroengrehab.biomedcentral.com/articles/10.1186/s12984-024-01499-3

Techet al. (2024). Virtual reality in pain management & rehabilitation: An update. ASRA Pain Medicine News. https://asra.com/news-publications/asra-newsletter/newsletter-item/asra-news/2024/02/08/virtual-reality-in-pain-management-rehabilitation-an-update

Wainwright, T. W., et al. (2023). Enhanced recovery after surgery (ERAS) in spine surgery: A systematic review and meta-analysis. Spine. https://pmc.ncbi.nlm.nih.gov/articles/PMC12592135/

Zhang, D., et al. (2025). Evaluating the role of nursing interventions in enhanced recovery after surgery for minimally invasive spine surgery. Frontiers in Surgery. https://www.frontiersin.org/journals/surgery/articles/10.3389/fsurg.2025.1519135/full