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The biomechanical advantages to a load sharing anterior lumbar construct have not been debated. The development of a technique to place such a construct has gone through an evolution through PLIF, to open ALIF, to endoscopic ALIF. Recently the technique of a direct lateral mini-open approach has been popularized through the development of better retraction, improved visibility, and superior results. In the following chapter, we describe the technique, the indications, and the potentials for complications that surgeons need to comprehend before employing this powerful tool.

Minimally Invasive Extreme Lateral Trans-Psoas Approach to the Lumbar Spine: Applications and Techniques