Understanding Enhanced Surgical Recovery (ESR) Programs for Spine Surgery: Key Components, Benefits, and Innovations

 

Enhanced Surgical Recovery (ESR), also known as Enhanced Recovery After Surgery (ERAS), is a modern approach to help people recover faster and better from spine surgery. This method uses a team of doctors, nurses, and other experts to plan care before, during, and after the operation. It focuses on reducing pain without too many strong drugs, getting patients out of the hospital sooner, and preventing them from coming back for more treatment. In this article, we will look at the main parts of ESR programs and how they reduce opioid use, shorten hospital stays, and lower readmission rates. We will also talk about the important roles of chiropractic care and nurse practitioners. In addition, we will explore new tools, such as virtual reality (VR), to help build strength and accelerate healing. All this is based on recent studies and expert views.

Spine surgery can resolve problems such as back pain caused by injuries or aging. However, recovery in the past often took a long time and required the use of many pain medications. ESR changes this process by implementing simple steps that work together. For instance, ESR involves teaching patients what to expect, ensuring they eat properly before surgery, and encouraging them to move soon after surgery. These steps make the body stronger and reduce risks. Studies show ESR can cut opioid use by up to 50% and help people go home a day or two earlier (Dagal et al., 2023). This leads to happier patients and lower hospital costs.

What Is Enhanced Surgical Recovery (ESR)?

ESR is a set of rules and protocols that guide the care of surgical patients. It started in general surgery but now works well for spine operations, such as fusions or disc repairs. The goal is to reduce the body’s stress from surgery and help it heal quickly. Unlike the old ways, where patients stayed in bed and used lots of pain pills, ESR gets people active fast with fewer drugs.

Key ideas in ESR include:

• Teamwork: Doctors, nurses, anesthesiologists, and therapists work together.
• Planning in Phases: Care starts before surgery, continues during surgery, and continues after.
• Focus on the Patient: Each plan fits the person’s needs, like their age or health issues.

Research from many hospitals shows that ESR is effective for various spine problems, from simple fixes to major deformity corrections (Zaed et al., 2023). One large review found that most ESR programs use about 12 steps, such as pain control and early walking (Berk et al., 2025).

Key Components of ESR Programs for Spine Surgery

ESR breaks down into three main parts: before surgery (pre-op), during surgery (intra-op), and after surgery (post-op). Each part has steps to make recovery smoother.

Pre-Operative Components

Before surgery, the focus is on preparing the body. This helps avoid problems later.

• Patient Education: Teach people about the surgery, what pain to expect, and how to move after. This reduces fear and helps them follow plans. Many programs use videos or books (Zaed et al., 2023).
• Nutritional Optimization: Check for low nutrition or anemia. Provide supplements or iron if needed. Poor nutrition can slow healing, so eating protein and carbs before surgery helps keep energy up (Soffin et al., 2022).
• Pain Prep: Start non-opioid meds like acetaminophen or gabapentin to control pain early. Stop smoking or drinking to lower risks (American Association of Nurse Anesthesiology, n.d.).
• Prehabilitation: Do exercises to build strength. This can include walking or simple stretches for two months before (Zaed et al., 2023).

These steps make surgery safer and recovery faster.

Intra-Operative Components

During the operation, the team uses methods to reduce harm to the body.

• Anesthesia Choices: Use short-acting drugs or total IV anesthesia to wake up quicker. Add meds like ketamine or lidocaine to control pain without opioids (Dagal et al., 2023).
• Fluid Management: Provide just enough fluids to avoid swelling or low blood pressure.
• Minimally Invasive Techniques: Make small cuts to minimize muscle damage. This allows for faster recovery after surgery (Dietz et al., 2019).
• Local Pain Blocks: Inject numbing meds into the area to block pain right away.

These help patients feel better soon after waking up.

Post-Operative Components

After surgery, the goal is a speedy recovery.

• Early Mobilization: Get out of bed within hours or the next day. Walk three times a day to build strength (Zaed et al., 2023).
• Pain Management: Use mixes of meds like NSAIDs, gabapentin, and ice. Opioids only if needed.
• Nutrition and Intake: Start drinking and eating soon, even clear liquids on day one.
• Monitoring: Check for potential problems, such as blood clots, with therapy and meds.

All these parts work together to cut risks and speed healing.

Strategies for Reducing Opioid Use in ESR

Opioids are strong pain drugs, but they can cause addiction and side effects like nausea. ESR use is cut in half in many cases (Dagal et al., 2023). Here’s how:

• Multimodal Pain Control: Mix non-opioids like acetaminophen, NSAIDs, and nerve meds. Start before surgery and continue after. One study showed less than 2% need IV opioids (HCA Healthcare, n.d.).
• Patient Education: Teach about pain and non-drug options, such as ice or breathing techniques.
• Local and Regional Blocks: Number the area during surgery so it lasts for hours after.
• Early Movement: Walking reduces pain by improving blood flow.

In spine fusion, ESR dropped in-hospital opioids from 781 to 374 units without more pain (Dagal et al., 2023). This lowers addiction risk and helps people feel normal faster.

Shortening Hospital Stays with ESR

Long hospital stays cost money and raise infection risks. ESR shortens them by 1-2 days on average (HCA Healthcare Today, 2022).

• Early Mobilization: Walking soon after injury helps build strength and prevents clots.
• Quick Nutrition: Eating early provides energy for healing.
• Pain Control: Better pain means less time in bed.
• Team Checks: Daily reviews to send home when ready.

One program saw stays drop from 3.91 to 3.69 days (Dagal et al., 2023). Patients report healing comfortably at home sooner.

Lowering Readmission Rates Through ESR

Coming back to the hospital within 30 days is bad. ESR lowers this by 54% in some cases (HCA Healthcare Today, 2022).

• Education and Planning: Teach self-care and signs of problems.
• Follow-Up: Calls or visits after going home.
• Reduced Complications: Fewer infections or pain issues from better prep.
• Multimodal Care: Controls swelling and clots early.

Studies show lower rates of complications, such as urinary problems or confusion (Berk et al., 2025). This keeps people out of the hospital.

The Role of Integrative Chiropractic Care in ESR

Chiropractic care uses hands-on methods to fix body alignment. It fits perfectly in ESR for spine surgery recovery.

• Prehabilitation: Adjustments improve posture and mobility before surgery.
• Pain Relief: Non-opioid techniques, such as soft-tissue work, reduce tension.
• Post-Surgery Help: After healing, it cuts scar tissue and builds strength (New York City Spine, n.d.).
• Nerve Support: Relieves pinches to improve signal transmission and reduce pain.

Chiropractors work with teams to make recovery smoother. One approach addresses muscle spasms and aids gait (Active Health Center, n.d.). This complements physical therapy.

The Significant Role of Nurse Practitioners in ESR

Nurse practitioners (NPs) are advanced nurses who manage care. They are key in ESR.

• Coordination: Link doctors, therapists, and patients.
• Education: Explain plans and meds, especially non-opioids.
• Monitoring: Check progress and adjust pain control.
• Medication Management: Focus on safe, low-opioid options.

NPs bridge gaps for better adherence. In spine care, they handle follow-ups and prevent issues (American Association of Nurse Anesthesiology, n.d.).

Utilizing New Technologies: Virtual Reality (VR) in Post-Surgery Recovery

VR is a tech that creates fake worlds for exercises. It helps spine surgery patients build strength and recover.

• Engaging Therapy: Games make rehab fun and improve hand dexterity 3-12 months after (Nature, 2025).
• Pain Reduction: Distracts from the hurt and lowers perception.
• Strength Building: Tailored programs for motion and muscles (Jefferson Digital Commons, 2025).
• Home Use: Do exercises alone, such as lower-limb training (Frontiers in Neurology, 2017).
• Mental Boost: Improves focus and mood for better healing (SCIEPublish, 2025).

VR enhances ESR by making recovery more interactive. For scoliosis, or the spine, it strengthens without boredom (Treating Scoliosis, 2025).

Clinical Observations from Dr. Alexander Jimenez

Dr. Alexander Jimenez, DC, APRN, FNP-BC, combines chiropractic and NP skills for spine care. He notes that hybrid teams help with pain and rehab after injuries or surgery. For spine patients, he uses integrative plans with adjustments, nutrition, and telemedicine. He sees greater mobility with non-drug methods and emphasizes gut health for healing (Dr. Alex Jimenez, n.d.; LinkedIn, n.d.). His clinic treats sciatica and back pain with safe, team-based recovery.

Conclusion

ESR programs improve spine surgery recovery. By using education, nutrition, early movement, and team care, they reduced opioid use, shortened stays, and lowered readmissions. Incorporating chiropractic and nurse practitioner roles enhances the effectiveness of ESR programs. New tech like VR brings fun and effectiveness to building strength. As more hospitals use ESR, patients get safer, faster healing. Talk to your doctor about these options for your care.

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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 Anesthesiology. (n.d.). Enhanced recovery after surgery. https://www.aana.com/practice/clinical-practice/clinical-practice-resources/enhanced-recovery-after-surgery/

Benchmark Physical Therapy. (2025). Virtual reality: Physical therapy revolutionized in 2025. https://www.benchmarkpt.com/blog/virtual-reality-physical-therapy-revolutionized-in-2025/

Berk, M., et al. (2025). Enhanced recovery after surgery (ERAS) in spine surgery: A systematic review and meta-analysis. https://pmc.ncbi.nlm.nih.gov/articles/PMC12592135/

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

Dietz, N., et al. (2019). Enhanced recovery after surgery (ERAS) protocols: Time to change practice?. https://www.medrxiv.org/content/10.1101/2020.08.16.20175943v1.full

Dr. Alex Jimenez. (n.d.). El Paso, TX doctor of chiropractic. https://dralexjimenez.com/

Foundation for Orthopaedic Research and Education. (n.d.). An enhanced recovery program significantly reduces postop opioid use in spine surgery patients. https://foreonline.org/an-enhanced-recovery-program-significantly-reduces-postop-opioid-use-in-spine-surgery-patients/

Frontiers in Neurology. (2017). Home-based virtual reality-augmented training improves lower limb function. https://www.frontiersin.org/journals/neurology/articles/10.3389/fneur.2017.00635/full

HCA Healthcare. (n.d.). With ESR, our patients report…. https://www.hcadam.com/api/public/content/f42a4095a6f9451baa991b5a56cad568?v=4786eda4&download=true

HCA Healthcare Today. (2022). HCA Healthcare’s innovative approach to surgical recovery. 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/

Jefferson Digital Commons. (2025). Virtual reality-enhanced rehabilitation for improving musculoskeletal function. https://jdc.jefferson.edu/cgi/viewcontent.cgi?article=1056&context=skmcstudentworks

LinkedIn. (n.d.). Dr. Alexander Jimenez DC, APRN, FNP-BC. https://www.linkedin.com/in/dralexjimenez/

Nature. (2025). Virtual reality-based training to augment recovery of hand dexterity. https://www.nature.com/articles/s41598-025-05793-5

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/

Norton Healthcare Provider. (n.d.). Study finds enhanced recovery after surgery (ERAS) protocols help recovery after lumbar fusion. https://nortonhealthcareprovider.com/news/eras-protocol-spine-surgery/

SCIEPublish. (2025). Effects of virtual reality (VR) rehabilitation on mental health in SCI patients. https://www.sciepublish.com/article/pii/622

Soffin, E. M., et al. (2022). Enhanced recovery after surgery (ERAS) protocol in spine surgery. https://pmc.ncbi.nlm.nih.gov/articles/PMC9293758/

Treating Scoliosis. (2025). Scoliosis rehab: Exploring innovative VR approaches. https://treatingscoliosis.com/blog/exploring-scoliosis-rehab-vrs-early-studies-potential/

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