Lumbar spondylolisthesis refers to the partial or complete slippage of the upper lumbar vertebrae with the lower lumbar vertebrae due to abnormal intervertebral connections, i.e., a pathological process resulting from a lumbar vertebra sliding forward on its lower lumbar vertebrae, which is called antislip if it slips backward relative to the lower vertebrae, and lumbar spondylolisthesis may or may not be accompanied by isthmic fissure. Lumbar spondylolisthesis occurs in about 95% of the L5 and L4 vertebrae, with an incidence of 82-90% in the L5 vertebrae and rare in other lumbar vertebrae. According to the etiology of lumbar spine slippage can be divided into the following categories: 1, congenital (dysplastic); 2, isthmic; 3, degenerative; 4, traumatic; 5, pathological; 6, medical (postoperative lumbar spine). Of these, degenerative is the most common. Lumbar spondylolisthesis that occurs in childhood or later is mainly caused by congenital developmental defects, chronic strain or stress injuries, and its causative factors include causes such as heavy lifting, weightlifting, soccer, sports training, trauma, abrasion and tearing. Degenerative lumbar spondylolisthesis, also commonly referred to as pseudosynovitis, is a structural abnormality due to degenerative changes in various structures of the lumbar spine, often occurring after the age of 50, this slippage is usually accompanied by lumbar spinal stenosis, sciatica, numbness, decreased muscle strength, etc., and mostly requires surgery. 1.What are the minimally invasive treatment methods for lumbar spondylolisthesis? For patients with lumbar spondylolisthesis, the first step is to clarify the location and nature of the pain, determine whether the pain is related to the spondylolisthesis and whether it is combined with other diseases that cause lumbar pain, such as: lumbar strain, sacroiliac arthritis, ankylosing spondylitis, etc. Many patients with lumbar spondylolisthesis are asymptomatic and are only discovered by chance during an X-ray examination. The current consensus is that asymptomatic lumbar spondylolisthesis generally does not require surgical treatment, and even with symptoms, most should be treated conservatively first. Surgery is only indicated for those who have failed conservative treatment or have nerve root symptoms in the lower extremities. In general, surgery should be considered for the following conditions: persistent low back pain that is not relieved by conservative treatment and seriously affects the patient’s life; persistent nerve root compression or spinal stenosis; severe lumbar spondylolisthesis with lumbosacral deformity; and radiographs that confirm the progression of the spondylolisthesis. The treatment principle of lumbar spondylolisthesis is decompression, fusion and internal fixation. For the slippage of about degree I, it is not advocated to reset as the purpose; for the slippage of degree II or above, reset becomes a purpose of surgery. In recent years, with the innovation of medical devices and the accumulation of surgical experience, many doctors have started to use minimally invasive methods to treat lumbar spondylolisthesis, and their initial efficacy is good. (3) AxialLumbarInterbodyFusion (AxiaLIF) with posterior percutaneous pedicle or small joint screw fixation; (4) Extreme/LateralInterbodyFusion (Extreme/ DirectLateralInterbodyFusion) with posterior percutaneous pedicle or small joint screw fixation; (5) Lumbar InterbodyFusion (ALIF) with posterior percutaneous pedicle or small joint screw fixation; (6) Lumbar InterbodyFusion with posterior percutaneous pedicle or small joint screw fixation DirectLateralInterbodyFusion,X/DLIF), posterior percutaneous pedicle or small joint screw internal fixation; (5) minimally invasive posterior repositioning, decompression TLIF surgery, etc. 2.How to choose the minimally invasive treatment method for lumbar spondylolisthesis? The treatment principles of lumbar spondylolisthesis are decompression, repositioning, fusion and internal fixation. Nerve decompression is the main means to relieve symptoms. It is controversial whether nerve root decompression is needed for mild lumbar spondylolisthesis, and most authors advocate nerve decompression for severe spondylolisthesis to relieve symptoms. There are many methods of spinal fusion, which can be divided into intervertebral fusion, posterior posterolateral fusion, and circumferential 360° fusion of the vertebral body according to the site of bone grafting, and into anterior intervertebral fusion, posterior intervertebral fusion, transforaminal intervertebral fusion, and posterior posterolateral fusion according to the surgical approach. Theoretically, intervertebral fusion is better than posterior posterolateral fusion because the anterior middle column of the vertebral body bears 80% of the spinal load, while the posterior structure bears only 20%, and Wolf’s law states that the potential for bone fusion is greater with bone grafting blocks under pressure, and intervertebral bone grafting or placement of intervertebral fusion devices not only improves the potential for bone fusion, but also restores the height of the disc The intervertebral bone graft or placement of an intervertebral fusion device not only improves the fusion potential but also restores the disc height, optimizes the sagittal balance and adjusts the coronal alignment. In addition, there is still much controversy as to whether a slipped vertebral body needs to be repositioned and to what extent it should be repositioned, and most scholars do not advocate extended surgery to force complete anatomical repositioning. Minimally invasive surgery is generally only applicable to patients with mild to moderate lumbar spondylolisthesis, while patients with severe lumbar spondylolisthesis are generally not suitable for treatment by minimally invasive methods. In terms of simplicity, safety, and effectiveness, posterior minimally invasive TLIF surgery is the easiest procedure, allowing for decompression, fusion, and internal fixation through a single posterior approach. For patients undergoing secondary surgery, or in cases where the posterior structures are destroyed and the nerve root and dural sac adhesions are so severe that it is difficult to do posterior posterolateral and interbody fusion from the posterior, various minimally invasive methods such as laparoscopic anterior lumbar fusion, small incision anterior lumbar interbody fusion, axial lumbar interbody fusion, and extreme posterolateral interbody fusion can be used to perform anterior fusion, followed by minimally invasive pedicle or internal fixation with articular protrusion screws.