Despite the extraordinary advances in the last decades, adult spinal deformity (ASD) remains to this day one of the most formidable challenges presenting to spine surgeons. We have managed to improve by orders of magnitude our understanding of the biomechanical and pathophysiological principles on the basis of the disease, our diagnostic tools, the knowledge of the personal and socio-economic burden, and, more decisively, the surgical armamentarium available [
8]. Though it is clear that we have come a long way since the Harrington rod, it is also undeniable that we often ended up less impressed by the results of surgery or overwhelmed by the complications it entails for a particularly frail patient group. In that sense, following the enthusiasm brought in by minimally invasive surgery (MIS) and techniques to the treatment of other spinal pathologies, the next obvious step was to try and adapt them to the treatment of degenerative adult deformity. The appeal was obvious: to minimize the aggressiveness of surgery and therefore costs/complications, while at least maintaining the same efficacy. This has been extensively studied, including comparative studies on the advantages and pitfalls of MIS vs open surgery [
9], and MIS techniques have been progressively integrated in the rationale of surgical treatment [
5]. However, very few studies have been published with follow-up greater than 2 years [
1,
2], so long-term outcomes have been severely lacking. …
