{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,17]],"date-time":"2026-09-17T16:50:38Z","timestamp":1789663838907,"version":"4.0.1"},"reference-count":28,"publisher":"Journal of Neurosurgery Publishing Group (JNSPG)","issue":"5","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2025,11,1]]},"abstract":"<jats:sec>\n                    <jats:title>OBJECTIVE<\/jats:title>\n                    <jats:p>Previous studies have demonstrated the benefit of early ambulation in patients who have undergone elective spine surgery. However, there are limited data on how early patients can feasibly move about in the postoperative period and whether there is further benefit in an ultra-early postoperative ambulation time frame. Current Michigan protocols aim for 80% of all patients ambulating within 8 hours of surgery end time. The goal of this retrospective study was to determine whether patients who ambulate within 4 hours of surgery have any greater benefit than those who ambulate 4\u20138 hours after surgery.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>METHODS<\/jats:title>\n                    <jats:p>The Michigan Spine Surgery Improvement Collaborative database was queried for patients who had undergone elective spine surgery between January 2020 and May 2024. Patients were categorized into two groups based on the time to ambulation: &lt; 4 hours postoperatively (ultra-early) and 4\u20138 hours postoperatively. Patients who had 4 or more levels altered, a durotomy, or CSF leakage were excluded from analysis. Primary outcomes were the presence of any complication and hospital length of stay. Secondary outcomes included patient-reported outcomes. A multivariate analysis was conducted to adjust for potential confounders.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>RESULTS<\/jats:title>\n                    <jats:p>A total of 21,725 patients were included in the study. Compared to the ultra-early cohort, the patients who ambulated 4\u20138 hours postoperatively were more likely to have complications (RR 1.14, 95% CI 1.04\u20131.26, p = 0.005), more likely to be readmitted after surgery (RR 1.18, 95% CI 1.03\u20131.35, p = 0.020), less likely to be discharged to home (RR 0.99, 95% CI 0.98\u20131.00, p = 0.005), and less likely to reach a minimal clinically important difference in back pain 1 year after surgery (RR 0.96, 95% CI 0.93\u20130.99, p = 0.022). The ultra-early ambulation cohort had a 0.47-day shorter length of stay (95% CI 0.34\u20130.6, p &lt; 0.001) relative to the 4- to 8-hour cohort.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>CONCLUSIONS<\/jats:title>\n                    <jats:p>Ambulating patients in an ultra-early manner, that is, &lt; 4 hours after spine surgery, is feasible and demonstrates a potential benefit in the outcomes of elective spine surgery. The benefits appear to be a lower risk of complications and lower likelihood of readmission.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3171\/2025.5.spine25314","type":"journal-article","created":{"date-parts":[[2025,9,12]],"date-time":"2025-09-12T14:34:33Z","timestamp":1757687673000},"page":"601-606","source":"Crossref","is-referenced-by-count":2,"title":["Ultra-early postoperative ambulation in spine surgery: a Michigan Spine Surgery Improvement Collaborative study"],"prefix":"10.3171","volume":"43","author":[{"given":"Anisse N.","family":"Chaker","sequence":"first","affiliation":[{"name":"Department of Neurosurgery, Henry Ford Health, Detroit;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kylie","family":"Springer","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Henry Ford Health, Detroit;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kari","family":"Jarabek","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Henry Ford Health, Detroit;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yousif","family":"Jafar","sequence":"additional","affiliation":[{"name":"School of Medicine, Wayne State University, Detroit;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Saleh","family":"Al-Juburi","sequence":"additional","affiliation":[{"name":"School of Medicine, Wayne State University, Detroit;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alexander","family":"Hayes","sequence":"additional","affiliation":[{"name":"School of Medicine, Wayne State University, Detroit;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Heegook","family":"Yeo","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Henry Ford Health, Detroit;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jianhui","family":"Hu","sequence":"additional","affiliation":[{"name":"Department of Public Health Sciences, Henry Ford Health, Detroit;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lonni","family":"Schultz","sequence":"additional","affiliation":[{"name":"Department of Public Health Sciences, Henry Ford Health, Detroit;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dheeraj","family":"Kagithala","sequence":"additional","affiliation":[{"name":"School of Medicine, Wayne State University, Detroit;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jawad","family":"Saad","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Henry Ford Health, Detroit;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Edvin","family":"Telemi","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Henry Ford Health, Detroit;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tarek R.","family":"Mansour","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Henry Ford Health, Detroit;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Muwaffak","family":"Abdulhak","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Henry Ford Health, Detroit;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"David R.","family":"Nerenz","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Henry Ford Health, Detroit;"},{"name":"Center for Health Policy and Health Services Research, Henry Ford Health, Detroit;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kenneth","family":"Easton","sequence":"additional","affiliation":[{"name":"Department of Orthopedics, University of Michigan Health-West, Grand Rapids;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kevin","family":"Taliaferro","sequence":"additional","affiliation":[{"name":"Department of Orthopedics, Henry Ford Health, Detroit;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Noojan","family":"Kazemi","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, University of Michigan, Ann Arbor;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Miguelangelo","family":"Perez-Cruet","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Corewell Royal Oak Hospital, Royal Oak;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ilyas","family":"Aleem","sequence":"additional","affiliation":[{"name":"Department of Orthopedics, University of Michigan, Ann Arbor;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Richard","family":"Easton","sequence":"additional","affiliation":[{"name":"Department of Orthopedics, Corewell Troy Hospital, Troy; and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jad G.","family":"Khalil","sequence":"additional","affiliation":[{"name":"Department of Orthopedics, Corewell Royal Oak Hospital, Royal Oak, Michigan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Victor","family":"Chang","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Henry Ford Health, Detroit;"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1754","reference":[{"issue":"2","key":"b1","series-title":"Dig Surg","first-page":"123","article-title":"Multimodal perioperative rehabilitation in elective conventional resection of colonic cancer: results from the German Multicenter Quality Assurance Program \u2018Fast-Track Colon II.\u2019","volume":"26","author":"Braumann C","year":"2009","unstructured":"Braumann C, Guenther N, Wendling P,  Multimodal perioperative rehabilitation in elective conventional resection of colonic cancer: results from the German Multicenter Quality Assurance Program \u2018Fast-Track Colon II.\u2019. Dig Surg. 2009;26(2):123\u2013129."},{"issue":"7","key":"b2","series-title":"Dis Colon Rectum","first-page":"851","article-title":"Prospective, randomized, controlled trial between a pathway of controlled rehabilitation with early ambulation and diet and traditional postoperative care after laparotomy and intestinal resection","volume":"46","author":"Delaney CP","year":"2003","unstructured":"Delaney CP, Zutshi M, Senagore AJ, Remzi FH, Hammel J, Fazio VW. Prospective, randomized, controlled trial between a pathway of controlled rehabilitation with early ambulation and diet and traditional postoperative care after laparotomy and intestinal resection. Dis Colon Rectum. 2003;46(7):851\u2013859."},{"issue":"8","key":"b3","series-title":"Br J Surg","first-page":"1015","article-title":"Randomized clinical trial on enhanced recovery versus standard care following open liver resection","volume":"100","author":"Jones C","year":"2013","unstructured":"Jones C, Kelliher L, Dickinson M,  Randomized clinical trial on enhanced recovery versus standard care following open liver resection. Br J Surg. 2013;100(8):1015\u20131024."},{"issue":"4","key":"b4","series-title":"Am J Surg","first-page":"496","article-title":"Early ambulation after surgery","volume":"78","author":"Trice ET","year":"1949","unstructured":"Trice ET. Early ambulation after surgery. Am J Surg. 1949;78(4):496\u2013499."},{"issue":"3","key":"b5","series-title":"Neurosurgery","first-page":"505","article-title":"Validation of the benefits of ambulation within 8 hours of elective cervical and lumbar surgery: a Michigan Spine Surgery Improvement Collaborative study","volume":"91","author":"Lim S","year":"2022","unstructured":"Lim S, Bazydlo M, Macki M,  Validation of the benefits of ambulation within 8 hours of elective cervical and lumbar surgery: a Michigan Spine Surgery Improvement Collaborative study. Neurosurgery. 2022;91(3):505\u2013512."},{"issue":"5","key":"b6","series-title":"Spine J","first-page":"812","article-title":"Safety and benefit of ambulation within 24 hours in elderly patients undergoing lumbar fusion: propensity score matching study of 882 patients","volume":"24","author":"Wang SK","year":"2024","unstructured":"Wang SK, Li YJ, Wang P,  Safety and benefit of ambulation within 24 hours in elderly patients undergoing lumbar fusion: propensity score matching study of 882 patients. Spine J. 2024;24(5):812\u2013819."},{"key":"b7","series-title":"Public Health","first-page":"76","article-title":"Spatial access to health care and elderly ambulatory care sensitive hospitalizations","volume":"169","author":"Huang Y","year":"2019","unstructured":"Huang Y, Meyer P, Jin L. Spatial access to health care and elderly ambulatory care sensitive hospitalizations. Public Health. 2019;169:76\u201383."},{"issue":"9","key":"b8","series-title":"Orthop Surg","first-page":"2354","article-title":"Does immediate postoperative early ambulation affect clinical results of full-endoscopic lumbar discectomy? A historical control study of daytime operation with a 8-hour hospital stay versus inpatient operation","volume":"15","author":"Yu L","year":"2023","unstructured":"Yu L, Zhu B, Dong H,  Does immediate postoperative early ambulation affect clinical results of full-endoscopic lumbar discectomy? A historical control study of daytime operation with a 8-hour hospital stay versus inpatient operation. Orthop Surg. 2023;15(9):2354\u20132362."},{"key":"b9","series-title":"Front Surg","first-page":"860140","article-title":"Whether out-of-bed activity restriction in the early postoperative period of PELD is beneficial to therapeutic efficacy or reduce recurrence","volume":"9","author":"Liang X","year":"2022","unstructured":"Liang X, Wang Y, Yue Y, Li Y, Meng C. Whether out-of-bed activity restriction in the early postoperative period of PELD is beneficial to therapeutic efficacy or reduce recurrence. Front Surg. 2022;9:860140."},{"issue":"1","key":"b10","series-title":"Anaesthesiol Intensive Ther","first-page":"71","article-title":"Enhanced Recovery After Surgery (ERAS) protocols for spine surgery\u2014review of literature","volume":"54","author":"Naftalovich R","year":"2022","unstructured":"Naftalovich R, Singal A, Iskander AJ. Enhanced Recovery After Surgery (ERAS) protocols for spine surgery\u2014review of literature. Anaesthesiol Intensive Ther. 2022;54(1):71\u201379."},{"issue":"6","key":"b11","series-title":"Neurosurg Focus","first-page":"E7","article-title":"The Michigan Spine Surgery Improvement Collaborative: a statewide Collaborative Quality Initiative","volume":"39","author":"Chang V","year":"2015","unstructured":"Chang V, Schwalb JM, Nerenz DR,  The Michigan Spine Surgery Improvement Collaborative: a statewide Collaborative Quality Initiative. Neurosurg Focus. 2015;39(6):E7."},{"issue":"6","key":"b12","series-title":"Acta Orthop","first-page":"732","article-title":"High degree of kinesiophobia after lumbar disc herniation surgery: a cross-sectional study of 84 patients","volume":"82","author":"Svensson GL","year":"2011","unstructured":"Svensson GL, Lundberg M, Ostgaard HC, Wendt GK. High degree of kinesiophobia after lumbar disc herniation surgery: a cross-sectional study of 84 patients. Acta Orthop. 2011;82(6):732\u2013736."},{"issue":"10","key":"b13","series-title":"Spine J","first-page":"S254","article-title":"Postoperative ambulation in patients undergoing total hip arthroplasty, total knee arthroplasty and elective lumbar spine surgery to treat arthritic pathologies","volume":"15","author":"Green AJ","year":"2015","unstructured":"Green AJ, Manson NA, Cochran M, Abraham EP. Postoperative ambulation in patients undergoing total hip arthroplasty, total knee arthroplasty and elective lumbar spine surgery to treat arthritic pathologies. Spine J. 2015;15(10):S254."},{"issue":"5","key":"b14","series-title":"Spine J","first-page":"759","article-title":"Early postoperative fear of movement predicts pain, disability, and physical health six months after spinal surgery for degenerative conditions","volume":"14","author":"Archer KR","year":"2014","unstructured":"Archer KR, Seebach CL, Mathis SL, Riley LH, Wegener ST. Early postoperative fear of movement predicts pain, disability, and physical health six months after spinal surgery for degenerative conditions. Spine J. 2014;14(5):759\u2013767."},{"issue":"2","key":"b1","series-title":"Dig Surg","first-page":"123","article-title":"Multimodal perioperative rehabilitation in elective conventional resection of colonic cancer: results from the German Multicenter Quality Assurance Program \u2018Fast-Track Colon II.\u2019","volume":"26","author":"Braumann C","year":"2009","unstructured":"Braumann C, Guenther N, Wendling P,  Multimodal perioperative rehabilitation in elective conventional resection of colonic cancer: results from the German Multicenter Quality Assurance Program \u2018Fast-Track Colon II.\u2019. Dig Surg. 2009;26(2):123\u2013129."},{"issue":"7","key":"b2","series-title":"Dis Colon Rectum","first-page":"851","article-title":"Prospective, randomized, controlled trial between a pathway of controlled rehabilitation with early ambulation and diet and traditional postoperative care after laparotomy and intestinal resection","volume":"46","author":"Delaney CP","year":"2003","unstructured":"Delaney CP, Zutshi M, Senagore AJ, Remzi FH, Hammel J, Fazio VW. Prospective, randomized, controlled trial between a pathway of controlled rehabilitation with early ambulation and diet and traditional postoperative care after laparotomy and intestinal resection. Dis Colon Rectum. 2003;46(7):851\u2013859."},{"issue":"8","key":"b3","series-title":"Br J Surg","first-page":"1015","article-title":"Randomized clinical trial on enhanced recovery versus standard care following open liver resection","volume":"100","author":"Jones C","year":"2013","unstructured":"Jones C, Kelliher L, Dickinson M,  Randomized clinical trial on enhanced recovery versus standard care following open liver resection. Br J Surg. 2013;100(8):1015\u20131024."},{"issue":"4","key":"b4","series-title":"Am J Surg","first-page":"496","article-title":"Early ambulation after surgery","volume":"78","author":"Trice ET","year":"1949","unstructured":"Trice ET. Early ambulation after surgery. Am J Surg. 1949;78(4):496\u2013499."},{"issue":"3","key":"b5","series-title":"Neurosurgery","first-page":"505","article-title":"Validation of the benefits of ambulation within 8 hours of elective cervical and lumbar surgery: a Michigan Spine Surgery Improvement Collaborative study","volume":"91","author":"Lim S","year":"2022","unstructured":"Lim S, Bazydlo M, Macki M,  Validation of the benefits of ambulation within 8 hours of elective cervical and lumbar surgery: a Michigan Spine Surgery Improvement Collaborative study. Neurosurgery. 2022;91(3):505\u2013512."},{"issue":"5","key":"b6","series-title":"Spine J","first-page":"812","article-title":"Safety and benefit of ambulation within 24 hours in elderly patients undergoing lumbar fusion: propensity score matching study of 882 patients","volume":"24","author":"Wang SK","year":"2024","unstructured":"Wang SK, Li YJ, Wang P,  Safety and benefit of ambulation within 24 hours in elderly patients undergoing lumbar fusion: propensity score matching study of 882 patients. Spine J. 2024;24(5):812\u2013819."},{"key":"b7","series-title":"Public Health","first-page":"76","article-title":"Spatial access to health care and elderly ambulatory care sensitive hospitalizations","volume":"169","author":"Huang Y","year":"2019","unstructured":"Huang Y, Meyer P, Jin L. Spatial access to health care and elderly ambulatory care sensitive hospitalizations. Public Health. 2019;169:76\u201383."},{"issue":"9","key":"b8","series-title":"Orthop Surg","first-page":"2354","article-title":"Does immediate postoperative early ambulation affect clinical results of full-endoscopic lumbar discectomy? A historical control study of daytime operation with a 8-hour hospital stay versus inpatient operation","volume":"15","author":"Yu L","year":"2023","unstructured":"Yu L, Zhu B, Dong H,  Does immediate postoperative early ambulation affect clinical results of full-endoscopic lumbar discectomy? A historical control study of daytime operation with a 8-hour hospital stay versus inpatient operation. Orthop Surg. 2023;15(9):2354\u20132362."},{"key":"b9","series-title":"Front Surg","first-page":"860140","article-title":"Whether out-of-bed activity restriction in the early postoperative period of PELD is beneficial to therapeutic efficacy or reduce recurrence","volume":"9","author":"Liang X","year":"2022","unstructured":"Liang X, Wang Y, Yue Y, Li Y, Meng C. Whether out-of-bed activity restriction in the early postoperative period of PELD is beneficial to therapeutic efficacy or reduce recurrence. Front Surg. 2022;9:860140."},{"issue":"1","key":"b10","series-title":"Anaesthesiol Intensive Ther","first-page":"71","article-title":"Enhanced Recovery After Surgery (ERAS) protocols for spine surgery\u2014review of literature","volume":"54","author":"Naftalovich R","year":"2022","unstructured":"Naftalovich R, Singal A, Iskander AJ. Enhanced Recovery After Surgery (ERAS) protocols for spine surgery\u2014review of literature. Anaesthesiol Intensive Ther. 2022;54(1):71\u201379."},{"issue":"6","key":"b11","series-title":"Neurosurg Focus","first-page":"E7","article-title":"The Michigan Spine Surgery Improvement Collaborative: a statewide Collaborative Quality Initiative","volume":"39","author":"Chang V","year":"2015","unstructured":"Chang V, Schwalb JM, Nerenz DR,  The Michigan Spine Surgery Improvement Collaborative: a statewide Collaborative Quality Initiative. Neurosurg Focus. 2015;39(6):E7."},{"issue":"6","key":"b12","series-title":"Acta Orthop","first-page":"732","article-title":"High degree of kinesiophobia after lumbar disc herniation surgery: a cross-sectional study of 84 patients","volume":"82","author":"Svensson GL","year":"2011","unstructured":"Svensson GL, Lundberg M, Ostgaard HC, Wendt GK. High degree of kinesiophobia after lumbar disc herniation surgery: a cross-sectional study of 84 patients. Acta Orthop. 2011;82(6):732\u2013736."},{"issue":"10","key":"b13","series-title":"Spine J","first-page":"S254","article-title":"Postoperative ambulation in patients undergoing total hip arthroplasty, total knee arthroplasty and elective lumbar spine surgery to treat arthritic pathologies","volume":"15","author":"Green AJ","year":"2015","unstructured":"Green AJ, Manson NA, Cochran M, Abraham EP. Postoperative ambulation in patients undergoing total hip arthroplasty, total knee arthroplasty and elective lumbar spine surgery to treat arthritic pathologies. Spine J. 2015;15(10):S254."},{"issue":"5","key":"b14","series-title":"Spine J","first-page":"759","article-title":"Early postoperative fear of movement predicts pain, disability, and physical health six months after spinal surgery for degenerative conditions","volume":"14","author":"Archer KR","year":"2014","unstructured":"Archer KR, Seebach CL, Mathis SL, Riley LH, Wegener ST. Early postoperative fear of movement predicts pain, disability, and physical health six months after spinal surgery for degenerative conditions. Spine J. 2014;14(5):759\u2013767."}],"container-title":["Journal of Neurosurgery: Spine"],"original-title":[],"link":[{"URL":"https:\/\/thejns.org\/view\/journals\/j-neurosurg-spine\/43\/5\/article-p601.xml","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/thejns.org\/downloadpdf\/journals\/j-neurosurg-spine\/43\/5\/article-p601.xml","content-type":"text\/html","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/thejns.org\/downloadpdf\/journals\/j-neurosurg-spine\/43\/5\/article-p601.xml","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,3,6]],"date-time":"2026-03-06T13:45:33Z","timestamp":1772804733000},"score":1,"resource":{"primary":{"URL":"https:\/\/thejns.org\/view\/journals\/j-neurosurg-spine\/43\/5\/article-p601.xml"}},"subtitle":["Presented at the 2025 AANS\/CNS Joint Section on Disorders of the Spine and Peripheral Nerves"],"short-title":[],"issued":{"date-parts":[[2025,11,1]]},"references-count":28,"journal-issue":{"issue":"5"},"URL":"https:\/\/doi.org\/10.3171\/2025.5.spine25314","relation":{},"ISSN":["1547-5654"],"issn-type":[{"value":"1547-5654","type":"print"}],"subject":[],"published":{"date-parts":[[2025,11,1]]}}}