The transosseous spinal core approach (TOSCA) represents a novel approach to the interior of the spine or disc space by removing a core from a first bone and performing a procedure, and/or making further enlargements and cuts in the first bone and performing a procedure, and/or making another cut into an adjacent disc space from the first bone hole and performing a procedure and/or continuing by cutting into another second bone and performing a procedure. The process can be further extended into additional spine levels by extending the cutting process. A core can be made at more than one level. The preferred surgical approach is a posterior lateral approach. An anterior surgical approach can be used as well. Any practical surgical approach or any combination of surgical approaches can be utilized to gain access to the first bone. Once the surgical soft tissue access to the first bone is completed TOSCA can be used to gain access to the interior of a vertebral body or disc space. After the procedure is completed in a vertebral body or disc space, usually at least a portion of the bone core is replaced to fill in the core hole.