The use of transperitoneal endoscopic approaches to the distal segments of the lumbar spine has recently been described. This has been the catalyst for the development of other minimally invasive anterior approaches to the spine. This review looks at the published results so far, and highlights the principles, techniques and complications. The limitations of laparoscopic approaches have meant that surgeons are moving on to endoscopic extraperitoneal and mini-open approaches, but important lessons have been learnt during this short rapid phase of development. The efficacy and safety of minimal access techniques in the spine have been established, and outcome standards set by which future techniques can be judged. The importance of proper training is emphasised.