1.MISS is defined as: the premise of ensuring the same or better surgical results than traditional open surgery, with specific surgical techniques to reduce the tissue damage caused by the surgical procedure, thereby reducing the incidence of post-operative complications and promoting faster functional recovery. To ensure the effectiveness of MISS surgery, the surgeon must make meticulous preoperative decisions and plan the surgery thoroughly, and thorough preoperative preparation has a tremendous impact on the surgical procedure and postoperative outcome. By working effectively in these ways, both surgeons and patients benefit from the potential positive results of MISS. Less tissue damage, less bleeding and spotting, less post-operative pain, faster recovery from post-operative activities, and shorter hospital stays to a quicker return to professional and personal daily activities. Most importantly, these gains from improved surgical access do not affect the final outcome; surgical outcomes are independent of the size of the surgical access, i.e., open surgery and minimally invasive surgical approaches are identical.2 The four pillars of MISS: microsurgical techniques, minimally invasive surgical access strategies, imaging and navigation techniques, and minimally invasive spinal surgical instrumentation and endosurgery. Of the four pillars, the surgical access strategy is something that clinicians must master and become proficient at. As the lesion is the “target” of the MISS surgical operation, the operator must establish a precise channel for “targeted surgery. The selection of the incision usually depends on the anatomical characteristics of the area where the lesion is targeted, with the smallest possible size, but also taking into account the aesthetic and functional impact. The access to the target area should be easy to reveal the lesion, maximize the potential lumen of the tissue, minimize trauma and allow for easy repair, and preserve muscle and tendon function. Therefore, the first consideration in MISS surgery is how to establish the most appropriate access to the lesion, rather than what kind of operation to perform in the lesion area. With great improvements in operating instruments and light sources and imaging systems, “all-endoscopic surgery” has made access more minimally invasive, and more and more surgeons prefer endoscopy to microscopy.3. Reviewing the 30-year history of MISS: Starting in the 1990s, the first decade of research focused on “how to reduce surgical trauma by improving surgical access”. after 2000 research has focused on improvements in MISS surgical techniques and whether they can achieve the desired results. Recent studies have focused on further evaluating the evidence-based medical evidence for the efficacy of MISS. 4, AOSpine general principles and MISS: The four general principles are stability, sequence, function, and biology. Although the principles of MISS are not always identical to those of AO, they must be taken into account when performing MISS surgery. Stabilization and restoration of sequence” is probably the most challenging AO rule for MISS surgery. It usually requires special instrumentation support and a combination of minimally invasive techniques to achieve. From an evidence-based perspective, as long as there is no existing and persistent instability, even in the presence of “slipped vertebrae”, when the patient has persistent radicular leg pain and mild low back pain, simple non-fusion minimally invasive spine surgery is still a good option. This is especially true for older patients. For spine surgery, foraminoscopic surgery is a major advancement! It relieves symptoms by removing the nucleus pulposus that is compressing the nerve through a special working tube that goes straight to the herniated area! With the advantages of minimal trauma, less pain and faster recovery, it is the preferred choice for treating herniated lumbar discs!