Recent Advances in Minimally Invasive Surgical Techniques for Adult Spinal Deformity and the Role of Lateral Lumbar Interbody Fusion

Minimally invasive surgery (MIS) for adult spinal deformities (MIS deformity surgery) incorporates MIS lumbar interbody fusion and percutaneous pedicle screw fixation (PPSF) without posterior corrective osteotomy. While MIS reduces complications associated with open deformity surgery, its efficacy in correcting sagittal imbalance remains limited. This review discusses recent advances in the techniques of MIS deformity surgery and changes in the indications. The lateral lumbar interbody fusion (LLIF) was more effective for increasing the lumbar lordotic angle compared with transforaminal interbody fusion. The LLIF at L5–S1 could significantly improve the lower lumbar lordotic angle. Proper use of PPSF was essential for lumbar angle correction after MIS interbody fusion. MIS iliac screws could reduce screw head prominence. Anterior column realignment released the anterior longitudinal ligament, increasing anterior disc height. Spinal robotics and single-position lateral and posterior approach did not seem to be effective at the present time. MIS deformity surgery demonstrated potential for correcting marked sagittal deformities. Recent advancements in MIS deformity surgery offer promise for sagittal deformity correction. However, further clinical experience and scientific data are required to optimize outcomes and reduce complications.