Abstract
Adult spinal deformity (ASD) represents one of the most disabling conditions in all of medicine. Traditional open ASD surgery has been associated with significant morbidity. Minimally invasive spine surgery (MISS) approaches have been developed and adapted with the goal of reducing complications. There has been a recent trend away from traditional open methods, such as complex three-column osteotomies, toward MISS approaches, including newer and more powerful realignment techniques. Specific MISS tools include percutaneous iliac fixation; multilevel transforaminal, lumbar, oblique, and anterior lumbar interbody fusions; and mini-open pedicle subtraction osteotomy and anterior column realignment. Overall complication rates have reduced, at the cost of new and potentially additive complication profiles introduced by the anterolateral approaches and staging. Ceiling effects to MISS deformity correction currently exist, and open ASD surgery continues to play an important role in select cases. This chapter begins with a critical appraisal of MISS versus open deformity surgery, followed by sections detailing specific MISS approaches, including posterior, lateral, anterior, circumferential, and hybrid techniques, and concludes by discussing potential future directions. MISS deformity correction represents an increasingly viable alternative to traditional open ASD correction. As techniques, technologies, and perioperative strategies continue to evolve, indications for MISS are likely to expand and outcomes improve.