I. Minimally invasive anterior lumbar interbody fusion (ALIF) 1. Transperitoneal laparoscopic ALIF Single-segment usually requires a 3-4 hole technique with 1-2 retraction channels, 1 endoscopic channel and 1 working channel, while multi-segment fusion requires a 5-6 hole technique. The operating table is tilted to a supine position with the head down (Trendelenburg position) and the bowel cavity is moved out of the pelvis by gravity. An incision is first made around the umbilicus to create the first access, and after inflation, the laparoscope is placed. An incision of approximately 25px in size is made on either side of the midline and a trocar is inserted to distract the small bowel. An incision of approximately 50px in size is made on the pubic bone to create a working channel, an 18mm trocar is inserted, the retroperitoneal fat is bluntly separated to avoid damage to the parasympathetic plexus, the retroperitoneum is cut, the median sacral vessels are treated, the bilateral iliac vessels are separated and retracted, the intervertebral space is exposed, the annulus fibrosus is cut on both sides of the median point of the disc, the disc is removed, the intervertebral space is propped open, and an intervertebral fusion device is placed. Due to the limitations of the anterior abdominal aorta and the bifurcation point of the iliac vessels, it is currently used for L5/S1 intervertebral fusion. For performing L4/5 interbody fusion, not only skilled technique is required, but it must be based on the local anatomy of the patient. In some patients, the L4/5 intervertebral space may be accessed through between the abdominal aorta and the inferior vena cava, or these large vessels may be distracted to one side, while attention needs to be paid to the separation of the descending iliolumbar vein by ligation. 2. retroperitoneal laparoscopic ALIF was first reported by Zucherma in 1995 and can be used for L1-S1 segmental lumbar lesions, overcoming the limitation of transperitoneal laparoscopy limited to L4-S1. The methods of expansion and maintenance of the retroperitoneal space include CO2, pneumoperitoneum expansion, balloon expansion without pneumoperitoneum (BERG), and a combination of both, with the balloon-assisted pneumoperitoneum technique being the current choice.BERG has the advantage of allowing the use of standard surgical instruments and is not limited by the size of the insertion or material. The patient is usually placed in the lateral or supine position. A 2-75px transverse incision is made at the level of the appropriate segment centered on the line connecting the eleventh rib and the anterior superior iliac crest. A trocar needle bluntly separates the muscle layer to the fatty retroperitoneal space, and a balloon is placed and slowly dilated to form the retroperitoneal space. The balloon is then removed and the retroperitoneal space is maintained with an automated retraction system or CO2 pneumoperitoneum. A working channel is established next to the midline of the abdomen corresponding to the lesioned segment, and the large abdominal vessels and iliac vessels are identified and detached and retracted. The subsequent operation is the same as transperitoneal laparoscopy, but ligation of the iliolumbar artery or lumbar artery is required when dealing with segments above L4. 3.Small incision anterior lumbar interbody fusion (Mini-ALIF) Mini-ALIF is a modified version of traditional open surgery. A transverse incision of about 3-100 px in length is made to the left of the midline of the corresponding lesion segment, the anterior sheath of the rectus abdominis muscle is incised, and the rectus abdominis muscle is bluntly separated to the anterior peritoneum, with two types of transperitoneal and retroperitoneal approaches. A special automatic retractor is used to retract the intraperitoneal organ tissues, and the large blood vessels are retracted by pulling hooks to expose the diseased intervertebral disc, and the fusion device is placed after removal of the disc. Axial Lumbar Interbody Fusion (AxiaLIF) Axial lumbar interbody fusion is a percutaneous or anterior sacral approach to the anterior lumbar spine, first reported by Cragg et al. in 2004. It is performed by making an approximately 50 px incision next to the coccyx and placing a trocar needle percutaneously, which enters the posterior sacral rectal space and then reaches the sacral surgical area (i.e., the S1/2 vertebral junction) under bi-directional fluoroscopic guidance. After establishing a working channel through the posterior sacral rectal space, the L5/S1 interspace is decompressed and the fusion material is inserted through the working channel and the sacral bony channel. Finally, a hollow fixation bolt is placed, thus completing the medial brace fixation of the L5 vertebral body to the S1 vertebral body along the medial axis of the L5 vertebra. Extreme/Direct Lateral Interbody Fusion (X/DLIF) X/DLIF is a modification of the anterior retroperitoneal interbody fusion approach, first reported by Pimenta in 2001, who has performed more than 100 anterior interbody fusions via the lumbaris major approach endoscopically since 1998. to perform XLIF, and a similar instrumentation for DLIF surgery was introduced by Pivot Mode. This type of exposure requires the patient to be in the right lateral position. A tiny incision is made at the lateral edge of the paraspinal muscle at the same level as the disc, and the retroperitoneal space is opened by finger dissection down the psoas major muscle. Another tiny incision is made above the psoas major muscle, and the spreader is inserted downward along the psoas major muscle and continuously separated. As it passes through the psoas major muscle, it is detected using electromyography tracing. The spreader is gradually advanced along the plane of the disc, then the disc is evacuated and finally the fusion device is implanted. IV. Posterior approach 1. Minimally invasive PLIF surgery Posterior Lumbar Interbody Fusion (PLIF) was first proposed by Cloward in the 1940s as an effective surgical approach for the treatment of lumbar degeneration, instability, slippage and discogenic disease. Minimally invasive PLIF surgery is performed by making a small incision 2-75 px adjacent to the midline corresponding to the diseased disc and then using a tubular expander or minimally invasive retractor for decompression, fusion, and bone grafting with the aid of an endoscope, microscope, headlamp, and ophthalmoscope, or under direct vision for decompression and bone grafting fusion with a minimally invasive retractor. After the fusion is completed, endoscopic, small incision or percutaneous internal fixation surgery can also be performed. 2. Minimally invasive TLIF surgery In order to overcome the disadvantages of pulling the nerve roots and dural sac during PLIF, Harms et al. proposed the transvertebral foramen lumbar interbody fusion? surgery (TLIF). The incision for minimally invasive TLIF surgery can be more lateral to the midline, and a small incision can be made at 4-125 px next to the midline to remove the small joint on one side into the posterior lateral aspect of the intervertebral disc after exposure, and its specific exposure and operation methods are similar to those of minimally invasive PLIF surgery.