This study aimed to analyze the evolving paradigms in spine surgery training driven by technological innovation and ethical imperatives, and to propose an integrated framework for contemporary spine surgical education. A narrative review of the current literature, educational models, and technological advancements was performed, with a focus on advanced training methods such as simulation, augmented reality (AR), virtual reality (VR), robotics, and artificial intelligence (AI). The review critically assessed the ethical landscape and global disparities in training access. Frameworks from leading spine societies and training centers were examined to identify trends and gaps. Technological tools, including high-fidelity simulators, robotic platforms, and AR/VR modules, have demonstrated effectiveness in enhancing trainee performance, reducing intraoperative errors, and supporting ethical learning environments. Nevertheless, significant challenges persist, including high costs, cultural resistance, a lack of curriculum standardization, and unequal global access. Emerging solutions include competency-based progression models, modular continuing professional development pathways, and AI-driven personalized learning. Spine surgery education must shift from traditional apprenticeship models to a technology-enabled, ethically grounded, and competency-based approach. Simulation, robotics, AI, and mixed-reality platforms can offer safe, standardized, and globally scalable solutions for surgical training. Collaborative action among institutions, policymakers, and professional societies is essential to democratize access and establish universal benchmarks for modern spine education.

Objective: Minimally invasive surgery (MIS) has attracted increasing interest for the excision of intradural extramedullary (IDEM) spinal cord tumors. While open surgery is associated with excellent rates of gross total resection (GTR), minimal neurological deficits, and favorable quality of life outcomes, MIS provides potential benefits including reduced morbidity, less postoperative pain, decreased tissue damage, reduced blood loss, and accelerated recovery. This study aimed to evaluate the efficacy of MIS compared to open techniques for IDEM tumor excision by analysing clinical outcomes and procedural advantages. Methods: This retrospective study included 80 patients who underwent surgery for IDEM tumors by a single surgeon between 2012 and 2019. Outcomes between MIS and open surgery were compared. Assessed parameters included intraoperative blood loss, operative duration, tumor location, postoperative visual analogue scale (VAS) scores, length of hospital stay, and time to return to work. The primary outcomes were GTR rates and complications; secondary outcomes comprised symptom relief and tumor recurrence. All patients were followed for at least 3 years. Statistical analysis was performed to evaluate differences between groups. Results: Of the 80 patients, 38 underwent MIS and 42 underwent open surgery. MIS was associated with significantly reduced blood loss (65 mL vs. 240 mL, p<0.01) and shorter hospital stays (4.4 days vs. 6.8 days, p<0.01). Although operative times were initially longer for MIS (160 minutes vs. 130 minutes), this was attributed to the learning curve. GTR rates were similar between the groups (94.6% MIS vs. 96.4% open, p=0.46). There were no significant differences in rates of cerebrospinal fluid leak, infection, or neurological complications (p=0.32). Postoperative VAS scores showed significant improvement at 1 and 3 months in the MIS group, but differences were no longer evident at 1 year. No patient in either group required revision surgery within 3 years (p=0.33). Conclusion MIS for IDEM tumor excision offers distinct advantages over open surgery, including reduced morbidity and faster recovery, while achieving comparable long-term outcomes. With the implementation of advanced MIS techniques, results equal or surpass those of traditional open approaches.

Methods: We evaluated sexually active male patients (n=22, 40.8±6.8 years) admitted for microdiscectomy with a questionnaire for assessing sexual function before and 8 weeks after surgery. The questionnaire included the Oswestry Disability Index, Hospital Anxiety Depression Score, and Brief Sexual Function Inventory (BSFI), as well as questions about perceived sexual dysfunction (frequency, performance, satisfaction). Results: The average preoperative Visual Analog Scale (VAS) score was 4.36±2.59 (n=18) for low back pain (LBP) and 6.81±2.1 (n=22) for leg pain. The mean preoperative BSFI score was 27.8±11.2. Among the five BSFI components, sexual drive was reduced in 63.0% of patients, while erection and ejaculation were affected in 40.9% and 31.8%, respectively. The VAS score for LBP had a negative correlation with the preoperative BSFI score (p <0.03). After LDH onset, 54.5% of patients noted a decrease in frequency, and 77.2% described a decrease in desire and satisfaction. At 8 weeks after surgery, the mean BSFI score significantly improved to 33.23 (p =0.002). Sexual drive was normal in 77.7% of patients, and erection and ejaculation were normal in 77.7% and 91.0%, respectively. Overall, 59.1% had resumed sexual intercourse within 6 weeks of surgery. Conclusions LDH resulted in sexual dysfunction in up to 77% of patients, which significantly improved after surgery. By 6 weeks, the majority had resumed sexual activity without undue discomfort. Therefore, this study supports counseling for patients with LDH about sexual function.