Essential innovations in spinal surgery: Contributions from the French school

French innovation has profoundly shaped the evolution of spinal surgery over the past fifty years. While many French contributions are now internationally recognized, few studies have explored their impact on the biomechanical understanding of the spine, the development of surgical techniques, or their broader implications. This review aims to trace France's contributions to advancing spinal physiology, deformity surgery, and spinal stabilization, while outlining future perspectives for the specialty. From a surgical standpoint, the work of Stagnara, Duval-Beaupère, Legaye, and Roussouly laid the foundation for modern concepts of sagittal balance and spinal alignment. Cotrel and Dubousset revolutionized scoliosis management by introducing the three-dimensional deformity model and segmental instrumentation. Meanwhile, Roy-Camille, Louis, Argenson, Onimus, and Marnay advanced spinal trauma surgery, surgical approaches, and instrumentation techniques. Technological innovations include EOS imaging, vertebroplasty, disc prostheses, PediGuard® pedicle guidance systems, preoperative planning tools, custom rods, and data analysis platforms. More recently, France has emerged as a key player in robotic surgery, artificial intelligence, personalized surgery, and surgical simulation. LEVEL OF EVIDENCE: V; Narrative review.