Abstract: Exosomes are extracellular vesicles with diameters ranging from 30 to 150 nm, carrying abundant bioactive substances such as nucleic acids, proteins, and lipids. They play a crucial role in intercellular communication and material exchange. In vitro and in vivo studies indicate that stem cell-derived exosomes can delay intervertebral disc degeneration through a triple mechanism: regulating molecules centered on microRNA, inhibiting apoptosis, reducing inflammatory factor expression, and maintaining extracellular matrix homeostasis. This paper systematically reviews the research progress on stem cell-derived exosomes in the treatment of intervertebral disc degeneration in recent years, deeply analyzes their mechanisms of action, and discusses the current challenges faced by the field as well as future development directions.