This chapter has reviewed the application of new minimal access techniques to the conventional surgical approaches for the treatment of spine disease. The common theme behind the derivation of these newer technical approaches is that "less is more," that is, a minimally invasive approach is a priori superior to the same procedure performed in a conventional "open" fashion. Although procedures such as the thorascopic sympathectomy support this contention compared with open thoracotomy, other minimally invasive approaches, like the laparoscopic ALIF, have shown fewer advantages compared with more conventional open techniques. The best approach is the one that yields the superior outcome. Cases in which minimally invasive techniques are proving to be as effective as conventional open approaches bear consideration, especially when procedural costs, decreased hospital stays, and decreased postoperative discomfort can be obtained while still achieving similar outcomes. The application of advancing technologies to age-old problems in spinal surgery has certainly provided neurosurgeons with numerous innovative ways to treat patients; however, sound clinical decision making is still the foundation required to apply these new techniques.

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