Although the earliest written descriptions of the surgical treatment for spinal pathology were reported by Paulus of Aegina (circa 690 to 625 BC),¹ reports of more modern procedures, such as a laminectomy to decompress the neural elements, were first published in 1829. Furthermore, it was not until 1891 that Hadra first reported the feasibility of using instrumentation in spinal surgery²; in 1911, Albee reported the first successful spine fusions, with a successful spinal arthrodesis for Pott disease,³ and Hibbs⁴ published a three-person case series on the feasibility of performing a spinal fusion to arrest the progression of spinal deformities.

Over the last 100 years, an improved understanding of normal and pathologic neuroanatomy and spinal column anatomy has led to dramatic advancements in spine surgery. In 1937, Mixter and Barr⁵ published a transdural approach for the treatment of herniated lumbar disks, and this morbid procedure remained the most common surgical intervention for an intervertebral disk herniation until Cloward⁶ reported the possibility of performing a posterior lumbar diskectomy with interbody fusion through an extradural approach in 1953.

The 1950s to 1970s saw a dramatic increase in the ability of spine surgeons to address complex pathology owing to the advent of more modern spine instrumentation. During this time, Harrington⁷, ⁸, ⁹ published extensively on the use of posterior rod-hook instrumentation for treatment of spinal deformities, and Dwyer and colleagues¹⁰,¹¹ reported on the feasibility of instrumentation in the anterior spine. Although the advent of more modern instrumentation allowed spine surgeons to treat many different types of spinal pathology, these surgical procedures also resulted in significant patient morbidity. Recognizing the problems associated with the extensive spinal procedures being performed in the 1960s, Yasargil and colleagues, as well as Masil, pioneered the use of microsurgical techniques, including the use of an operating microscope in spine surgery.¹²,¹³ The improved visualization allowed for smaller incisions and improved visualization of the operative field, which was instrumental in the development of the modern microdiskectomy procedure.¹⁴, ¹⁵, ¹⁶, ¹⁷ Although a microdiskectomy approach has become the standard for herniated disk disease, this procedure can be performed in a variety of ways ranging from endoscopic, using a tubular retractor, or using an open surgical approach. Each approach has a different profile for soft tissue injury and intraoperative blood loss. Although these techniques continue to evolve, surgeon and patient preferences continue to be the major driving force in the selection of a particular technique, as scientific data proving the superiority of one approach are currently lacking.