This is my second trip to the United States to study minimally invasive spine surgery for 3 weeks, and I will be studying at 2 hospitals including discoscopy, foraminoscopy, and various small access surgical techniques. Before I begin my study, I will document my knowledge of minimally invasive surgery and the minimally invasive procedures that I perform. What is minimally invasive surgery? Minimally invasive surgery is the collective term for a series of surgical operations designed to minimize soft tissue injury. I understand the meaning of “minimally invasive” in “can I do minimally invasive surgery”, which is often asked by patients, to mean the kind of treatment that can be done by “sticking a needle”. These “needle” treatments are known as “nucleolysis” and “radiofrequency ablation”. They are only two types of minimally invasive surgery, targeting minor spinal pathologies such as minor disc herniation or discogenic back pain or osteoarthritis of small joints. In addition to these, there are discoscopy, foraminoscopy, and small percutaneous access techniques, while the latter includes posterior transvertebral access, lateral access, and anterolateral access, among other increasingly diverse modalities. With the development of medical technology, minimally invasive surgery is gradually becoming a trend, but minimally invasive surgery is ultimately a method, not an end in itself. It is important to note that minimally invasive surgery has indications, and not all cases are suitable for minimally invasive surgery. Therefore, when we choose a treatment modality, we should first think about what problem we want to solve and then consider what method to use to achieve it. Just like when we go on a trip, we should first determine which city we are going to, and then check how many modes of transportation are available to reach that city, airplane, high-speed train, moving train, regular train or bus. Finally, we can choose according to our wishes and conditions. We can’t take a high-speed train to a city that doesn’t have access to high-speed rail, can we? After mastering some minimally invasive surgery techniques, I do feel that I have one more weapon and one more option to face the disease. For example, an obese patient with 12cm thick waist fat alone and a herniated disc in 2 segments, not to mention the trauma and difficulty of the surgery itself and the greater risk of postoperative wound infection. I used small access discectomy, interbody bone graft fusion, and percutaneous pedicle screw fixation to greatly reduce the intraoperative injury and postoperative risk. The drainage tube was removed the day after surgery and the patient was able to go to the floor with a very smooth wound recovery. Another example is a patient with multiple metastatic carcinomas in the spine. The tumor destroyed T11 and the vertebral body and compressed the T12 spinal cord causing incomplete paralysis of the lower limbs. The patient needed urgent surgical treatment, not only to remove the tumor from the T11-12 lamina and the spinal canal, but also to perform pedicle screw fixation from T9,10 to L1,2. The surgical involvement was extensive, but the patient was 70 years old and in poor health. Conventional incisional surgery involves extensive dissection, bleeding, long postoperative drainage placement, long bed rest, and physical exertion. I maintained the stability of the spine by percutaneous pedicle screw fixation, and only made a small incision in the segment that needed decompression to perform conventional incisional decompression surgery. On the contrary, if a conventional incision is used, the intraoperative damage is not to mention that the drainage flow on the first postoperative day often has to be more than 500 ml, and the postoperative drainage time is even 5 days or longer. In fact, minimally invasive is a concept that should not be understood as only a certain technique. For example, an out-of-town consultative surgery. The patient was a 79-year-old man with L2-3 spinal stenosis and slippage and L4-5 spinal stenosis. The conventional practice was to do a total laminectomy and decompression of L2-5, pedicle screw fixation, and bone graft fusion. The trauma was so great that I was worried that the patient would not be able to tolerate it and wanted to advise the patient to be treated conservatively. Both of the patient’s children are doctors, one is the chief of surgery at our hospital and the other is the director of the medical school. They said that the old man was in too much pain, his back was so painful that he could not sleep flat, only one position could be used without pain, and he could not walk at all with back pain and leg pain down to the ground, all conservative treatment modalities had been done with no effect, and the old woman was still in good health and wanted to make an effort. Due to the local medical condition, we could not do percutaneous fixation and decompression surgery of small channels. I used the method of L2-3,L4-5 bilateral open nerve root canal enlargement, nerve root adhesion release, discectomy, and still did pedicle screw fixation because there was slippage. The patient recovered very well after surgery. This is certainly not minimally invasive surgery in the formal sense, but the concept of minimizing surgical trauma is included. While enjoying the benefits of minimally invasive surgery, the potential harm of minimally invasive surgery should not be ignored. One important one is radiation damage. Because minimally invasive surgery is usually performed under fluoroscopy, long-term operation under radiation can be very harmful to physicians and nurses, and a number of physicians who perform this treatment have later discovered leukemia, thyroid tumors, etc. So, while encouraging patients to do a risk-benefit assessment, I am doing the same trade-off myself. For example, a single-segment lumbar decompression and fixation fusion procedure is not very invasive with a traditional incision, and there is an option to do decompression and fixation with a transmuscular approach, which may not necessarily require a small percutaneous access technique. Conversely, in a particularly obese patient with diabetes, minimally invasive surgery may be worthwhile. Finally, it is important to emphasize that the benefit of minimally invasive surgery is reduced damage, but that does not mean it is easy to perform. On the contrary, minimally invasive surgery is more complex and requires more skill and experience from the surgeon. Patients face surgical risks that are in some ways no less, and probably more, than those of open surgery, all as a result of limited visualization and manipulation through small incisions. In conclusion, minimally invasive is one of many surgical procedures to choose from, depending on the characteristics of the patient’s disease.