This spine surgery lecture covers cell and tissue biology of the spine. The main focus is on intervertebral disc biology and other spinal tissues. Each spinal structure contains cells with a distinct phenotype. Under healthy conditions, these cells maintain the specific, functional extracellular matrix. Cells can respond to internal/external signals by adjusting their metabolic function. The intervertebral disc is a highly complex tissue with three distinct zones (AF, NP, EP) and three specific cell types. The cellularity in the disc is very low. Vertebrae, facet joints, muscles and ligaments all have distinct functions, appropriate extracellular matrix and specific cell types.