Genomics in Spine Surgery

Abstract Genomic science is transforming spine surgery by enabling biologically informed risk assessment and personalized treatment. Traditional predictors often overlook patient-specific differences. New biomarkers—such as epigenetic clocks, telomere length, and transcriptomic profiles—offer measurable insights into aging, inflammation, and tissue resilience. These are associated with frailty indices, disability scores, and postoperative complications. This review emphasizes genomic applications in degenerative spine disease, deformity, and spinal cord injury. Genome-wide association studies-identified variants ( COL9A2 , MMP3 , and IL1B ) and methylation changes in SOX9 and ACAN influence disc degeneration and cellular aging. Dunedin Pace of Aging Calculated from the Epigenome surpasses chronological age in predicting surgical risk. Genomic platforms, combined with artificial intelligence-driven modeling and multi-omic integration, are advancing personalized spine care. As access improves, these tools could enhance surgical planning and outcomes through tailored strategies.