The last decade has seen an evolution of minimally invasive spine surgery with new technological developments. Minimally invasive spine surgery is thought to decrease postoperative pain and allow quicker recovery by limiting soft-tissue retraction and dissection. Advances in microscopy, tissue retractors, and specialized instruments have enabled surgeons to perform procedures through small incisions. As with the open approach, the goals of the minimally invasive approach are to adequately decompress the involved neural elements, stabilize the motion segment, and/or realign the spinal column according to the needs of the individual patient. This article is an overview of the current state of minimally invasive spine surgery and a discussion of the key biologic concepts of posterior lumbar decompression as well as posterior and lateral fusion techniques.