Minimal access to the posterolateral lumbar spine

The purported advantages of minimally invasive spine surgery over open microsurgical alternatives for lumbar decompression and fusion are attractive to patients, surgeons, and hospital administrators. Shorter hospital length of stay, less blood loss, shorter operating times, decreased use of postoperative narcotic analgesics, and a more rapid return to work have all been touted as advantages. In this review, we describe step-by-step techniques for minimal access posterolateral lumbar decompression and fusion. Key learning tasks for the introduction of each technique into practice are highlighted. The current quality of evidence for each approach is also critically evaluated.