Spine Surgery in Space.

INTRODUCTION

Prolonged exposure to microgravity alters spinal biomechanics, increases disc herniation risk, and complicates perioperative care. With commercial and deep-space missions on the horizon, the need for in-orbit surgical capability has gained prominence as a safeguard for astronaut health.

METHODS

A narrative review of PubMed, EMBASE, and Google Scholar through November 2024 identified human, animal, and in vitro studies addressing spinal physiology, pathology, or surgical feasibility in actual or simulated microgravity. Studies unrelated to the spine or lacking English full text were excluded.

RESULTS

Of 988 records, there were 85 that met inclusion criteria. Across study types, microgravity consistently produced spinal elongation, disc swelling, vertebral bone loss, and muscle atrophy, leading to elevated postflight spinal morbidity. Although no spine operations have been reported in orbit, analog studies describe key intraoperative challenges, including fluid containment, sterility, imaging, anesthesia, and hemodynamic control. Promising countermeasures encompass bisphosphonates, resistive exercise, robot-assisted instrumentation, and teleoperation. These data offer a generalizable framework for perioperative planning during long-duration missions.

DISCUSSION: Existing evidence clarifies physiological and logistic barriers to operative care. Targeted musculoskeletal countermeasures, coupled with tele-robotic and augmented-reality platforms, provide a realistic pathway to safe spine surgery during future long-duration missions. Further translational research and on-orbit validation are essential before clinical deployment. Birhiray D, Ghali A, Philipp T, Chilukuri S, Fiedler B, Lawand J, Deveza L. Spine surgery in space. Aerosp Med Hum Perform. 2025; 96(11):1000-1007.