This video shows the technique for Xtreme™ minimally invasive lumbar L5,S1 pedicle screw fusion, as part of a TLIF, or backing up ALIF. or OLIF. The same technique can be used for LLIF (XLIF DLIF) surgeries at L4,5 and above. Spine23's Xtreme™ MIS lumbar fusion allows a complete TLIF to be performed through a single midline dime sized 18mm or less incision or bilateral Wiltse dime sized insicions. Posterior lateral fusions can be done through a single midline or bilateral Wiltse incisions as small as 12mm in size.