Musculoskeletal degeneration in space: translational parallels with spaceflight-associated ocular pathology and surgical implications

Prolonged exposure to microgravity leads to rapid and widespread physiological changes, most notably musculoskeletal degeneration and spaceflight-associated neuro-ocular syndrome (SANS), which are often considered separate clinical challenges. This opinion piece suggests that these conditions may share overlapping upstream mechanisms - particularly cephalad fluid shifts, oxidative stress, and mitochondrial dysfunction - that contribute to system-wide maladaptation with important implications for surgical risk, countermeasure design, and mission readiness during long-duration spaceflight. We highlight translational links between skeletal catabolism, muscle and tendon atrophy, spinal structural changes, and the high prevalence of SANS characterized by optic disc edema, globe flattening, and altered cerebrospinal fluid dynamics. Central to this perspective is the role of mitochondrial stress and redox imbalance as unifying biological hubs connecting impaired mechanotransduction, vascular and neural vulnerability, and disrupted glymphatic clearance. We propose that targeting these shared pathways through integrated strategies - such as lower body negative pressure, targeted resistive exercise, nutritional and antioxidant optimization, and emerging tele-robotic surgical platforms - may offer a more cohesive framework than organ-specific countermeasures alone. While acknowledging technical and evidentiary limitations, we argue that a systems-based perspective can enhance surgical preparedness in space and provide translational insights for terrestrial aging, orthopedic recovery, and complex surgical care.