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This chapter describes percutaneous lumbar fusion techniques, including advantages and disadvantages, techniques, complications, and patient selection strategies. Pedicle screw instrumentation can be utilized to stabilize fusion for various spinal pathologies via the creation of a rigid and stable construct. Recent developments in instrumentation have enabled preservation of muscles, ligaments, and bony structures of the spine that help facilitate recovery and improve outcomes. Furthermore, percutaneous techniques preserve muscle and ligaments adjacent segment disease. With these advances in percutaneous pedicle instrumentation and numerous advantages over the traditional method, interest in this approach has and will continue to rise.

Scheuermann disease is the most common cause of thoracic kyphosis in adolescent, based on the anterior vertebral wedging that develops during the adolescent growth spurt. Physical appearance in adolescence and backpain in adulthood are commonly the reasons for medical consultation. The benign natural history of scheuermann kyphosis necessitates an individualized decision making for treatment options. Surgical treatment is currently performed with multilevel Ponte-osteotomies and modern pedicle screw instrumentation that enables posterior-only correction of the deformity. A proper determination of fusion level is crucial to achieve good result and to avoid adjacent level complications.

MIS spine surgeons have rapidly adopted the retroperitoneal transpsoas approach since its first introduction in 2001. Its use has been greatly expanded from simple indirect decompression from degenerative disc disease to complex spinal deformity correction and traumatic vertebral fractures. The technique offers a rapid approach to the disc space and availability of variety of large interbody grafts with excellent fusion rates whether used as stand-alone, with lateral plating, or with pedicle screw instrumentation for support. The advantage of using retroperitoneal transpsoas approach is faster operative time, less anesthesia to the patient, quicker recovery, and lower blood loss. However, thorough anatomical understanding of the surrounding lumbar plexus and meticulous technique must be observed to avoid potential serious complications. In this chapter we examine crucial surgical anatomy necessary for a successful outcome, provide detailed surgical technical notes, discuss surgical indications and patient selection, and finally review all potential complications and complication avoidance.