Advancements in technology have ushered in a new era in spine surgery, offering innovative tools and techniques that improve surgical precision, efficiency, and safety. By exploring emerging technologies and techniques for minimally invasive spine surgery (MISS), providers may better address the challenges posed by spine pathology in an aging population and the imperative for refined surgical strategies to optimize outcomes of patient well-being. This narrative review analyzes studies exploring emerging technologies in MISS that contribute to better visualization and surgical accuracy, highlighting their respective surgical indications, objective reports of patient outcomes and user experiences, limitations in their use, and barriers to widespread implementation. This paper examines a spectrum of MISS technologies, including exoscope-assisted procedures, navigation-guided surgery, and robotic-assisted techniques for a range of spinal pathologies. The findings demonstrate enhanced preoperative knowledge and planning, as well as improved intraoperative precision and visualization, which may minimize tissue injury, surgical time, and postoperative complications. These technologies also enable more ergonomic surgical positioning for physicians and improved displays of the surgical site to the entire surgical team. Despite the potential benefits of these emerging technologies, the high costs of equipment and maintenance, as well as limited opportunities for sufficient training associated with their implementation, continue to pose limitations for supplementing or replacing existing surgical techniques.

Intestinal bacteria contribute to the pathogenesis of non-alcoholic fatty liver disease(NAFLD).Recently developed microbial profiling techniques are beginning to shed light on the nature of the changes in the gut microbiota that accompany NAFLD and non-alcoholic steatohepatitis(NASH).In this review,we summarize the role of gut microbiota in the development of NAFLD,NASH,and hepatocellular carcinoma(HCC).We highlight the mechanisms by which gut microbiota contribute to NAFLD/NASH,including through alterations in gut epithelial permeability,choline metabolism,endogenous alcohol production,release of inflammatory cytokines,regulation of hepatic Toll-like receptor(TLR),and bile acid meta-bolism.In addition,we analyze possible mechanisms for enhanced hepatic carcinogenesis,including alterations in bile acid metabolism,release of inflammatory cytokines,and expression of TLR-4.Finally,we describe therapeutic approaches for NAFLD/NASH and preventive strategies for HCC involving modulation of the intestinal microbiota or affected host pathways.Although recent studies have pro-vided useful information,large-scale prospective studies are required to better characterize the intestinal microbiota and metabolome,in order to demonstrate a causative role for changes in the gut microbiota in the etiology of NAFLD/NASH,to identify new therapeutic strategies for NAFLD/NASH,and to develop more effective methods of preventing HCC.