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In this review, we summarize the major pathological processes associated with IVDD, including apoptosis, autophagy dysregulation, oxidative stress, inflammatory responses, and extracellular matrix (ECM) degradation. We further discuss alterations in glucose, lipid, and amino acid metabolism, with particular emphasis on the contribution of mitochondrial dysfunction to metabolic imbalance in disc cells. In addition, we outline the genetic, environmental, and signaling factors that regulate metabolic reprogramming, including pathways such as mTOR and AMPK. Finally, we review emerging metabolism-related therapeutic strategies, including metabolic enzyme modulation, antioxidants, and mitochondrial protectors. 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