The financial pressures on the health-care system and the push to reduce hospital stays have provided a strong impetus toward minimally invasive procedures in all surgical specialties. These procedures frequently are associated with decreased perioperative morbidity, decreased duration of hospital stay, and reduced costs. Minimally invasive procedures are often popularized in the media or are advertised, and surgeons sometimes feel pressure to use new procedures to maintain a competitive practice. However, these types of procedures frequently require highly specialized equipment and training, and their outcome in the context of more traditional approaches needs to be carefully considered. Additionally, these procedures are often associated with unique and sometimes catastrophic complications. Lumbar microdiscectomy, video-assisted thoracoscopic surgery, and kyphoplasty represent relatively new minimally invasive techniques in spine surgery. We will discuss the current status of these procedures and the evidence supporting their increasing use in the management of spine patients. Patient selection remains a key to success for the newer minimally invasive techniques.