Minimally invasive surgery is the trend and direction of spinal surgery development. Minimally invasive surgery has the advantages of less trauma, less bleeding, and faster postoperative recovery. However, many patients and even some domestic doctors have a certain bias in their understanding of minimally invasive spine surgery. Many people equate minimally invasive surgery with endoscopic surgery, subchannel surgery, and percutaneous surgery, thinking that the use of these instruments and techniques is minimally invasive surgery. Minimally invasive is a technique, but also an advanced concept. The purpose and significance of minimally invasive surgery is to minimize medically induced injuries during surgery and to achieve or approach the efficacy of open surgery without additional risks. With the advancement of auxiliary examination techniques and the continuous improvement of surgical instruments, the treatment means for the same disease reflect the process of minimally invasive. Since 1934, when Mixter and Barr established the relationship between disc herniation and sciatica, the trend toward minimally invasive surgery has been evident, from total laminectomy + dural dissection, to hemi-laminectomy + epidural approach, to classical laminectomy with decompression and nucleus pulposus removal, to percutaneous endoscopic discectomy, with increasing surgical results and gradually The trend toward minimally invasive surgery is evident, with improving surgical results and decreasing medically induced injuries. There is little controversy about this. The increasing expectations of patients for minimally invasive surgery, coupled with the continued promotion of minimally invasive device manufacturers, has prompted more and more surgeons to adopt various access and endoscopic means to reduce the surgical incision. However, “small incisions” and “endoscopic surgery” do not mean less tissue trauma. In fact, the blind pursuit of small incisions can lead to muscle atrophy and necrosis due to continuous compression of the muscles around the access. The use of “minimally invasive” surgery regardless of the condition is a practice of “minimally invasive for the sake of minimally invasive” rather than based on patient benefit. Mastering the indications for surgery is more important than mastering the surgical technique itself. Of course, some hospitals take advantage of patients’ fear of surgery and use various names of “minimally invasive” surgery without evidence of efficacy to cheat patients of their money, which is even more disgraceful. Therefore, minimally invasive surgery should not only focus on the use of new instruments and accesses to complete the surgery, but also on the minimally invasive improvement of existing open surgery, which is more meaningful in the current situation where minimally invasive surgery is becoming more and more common. Minimally invasive techniques are emerging, and it is not advisable to blindly pursue new techniques while ignoring their potential risks until they have been adequately tested by long-term follow-up and evidence-based medicine. It is important for patients to understand the short-term and long-term pros and cons of minimally invasive surgery before making the best decision for themselves.