BACKGROUND: Prehabilitation aims to optimize patients' physical and psychological status before spine surgery to enhance recovery. However, its effectiveness on postoperative outcomes remains remains to be controversial. This meta-analysis aims to evaluate Prehabilitation impact on pain, functional recovery, psychological status, and perioperative outcomes. METHODS: A systematic search of MEDLINE/PubMed, Web of Science, Scopus, and Embase was conducted through January 2025 using PRISMA guidelines. A total of 5738 records were initially identified through database searches, of which 3765 remained after duplicate removal. Studies comparing postoperative outcomes in patients undergoing spine surgery with and without prehabilitation were included. Meta-analysis was performed using a random-effects model, with subgroup analyses based on exercise inclusion. RESULTS: According to our inclusion criteria, twenty-seven studies (2449 participants) were deemed appropriate to be included in our study. Our meta-analysis showed prehabilitation significantly reduced postoperative back pain (SMD -0.4028, p = 0.0269) and improved trunk muscle strength (SMD 0.1472, p = 0.0142). However, no significant differences were observed for disability (SMD -0.3772, p-value = 0.5705), quality of life (SMD 0.0657, p-value = 0.5372), and leg pain (SMD -0.1921, p-value = 0.3920). In addition, depression, operation time, blood loss, or length of stay were shown to be comparable between the two groups of patients. CONCLUSIONS: Prehabilitation may reduce postoperative back pain and improve muscle function, but does not significantly impact disability, quality of life, or perioperative outcomes. Future research should refine protocols and identify patient subgroups that benefit most from prehabilitation.

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