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This technique is useful mostly at L4–5 and L5–S1 as supplemental fixation after an anterior approach (ALIF or AxiaLIF) and has the advantage of a minimal midline skin incision and soft tissue disruption. While biomechanically not as strong as the pedicle screw/rod constructs, the facet screws are mostly designed to block rotation.

The minimally invasive sacro-iliac joint fusion is a relatively new technique that has been shown to achieve good results. The SI joint is a recently recognized potential pain generator and the diagnosis requires a specific algorithm. The surgeon should always think of this potential source of pain in patients with back pain radiating to one of the legs and no concordant spinal pathology. While there are multiple available systems to perform this arthrodesis, they all aim to achieve at least three points of fixation through the joint.

The lumbar retroperitoneal transpsoas corpectomy technique is probably the most difficult minimally invasive technique to learn. The approach is similar to the discectomy technique, but has to be extended to span the two discs, above and below the pathologic vertebral body. Supplemental fixation with either a lateral plate or posterior pedicle screws is recommended.