Expanded Indications for Hybrid Spinal Fixation Systems; Combined Percutaneous Pedicle Screw Fixation and Open Approaches.

Background/Objectives: Minimally invasive (percutaneous) pedicle screw fixation (PPSF) was initially introduced for the treatment of degenerative spinal deformities. Since then, its indications have progressively expanded to a broad spectrum of spinal pathologies. This method has gained increasing acceptance in spinal surgery due to lower morbidity when compared with conventional open procedures. This study presents a comprehensive review of the recent literature on hybrid minimally invasive spinal instrumentation techniques, focusing on the combined use of PPSF with open or mini-open approaches and their roles in personalized surgical management. Methods: A literature search was conducted in PubMed and Web of Science to identify studies reporting expanded indications of percutaneous pedicle screw fixation (combined with other approaches), novel surgical techniques, and their clinical outcomes. Results: Thirty-five studies met the inclusion criteria and were categorized according to pathology. Most included studies were retrospective observational investigations corresponding to Oxford CEBM Levels III-IV evidence, with a smaller number of prospective studies and systematic reviews. Conclusions: The findings from this review highlight the expanding role of hybrid methods in the management of complex spinal disorders. These approaches provide adequate stability and enable decompression or deformity correction, while minimizing tissue trauma, blood loss, and perioperative morbidity, thereby facilitating improved recovery and functional outcomes. The included literature predominantly represents moderate levels of evidence, supporting a patient-specific, pathology-driven surgical strategy that optimizes individualized outcomes in spinal surgery.