Significant advances have been made in the contemporary management of thoracolumbar spinal deformities, including improved segmental bony fixation, techniques for osteotomy, and mechanically powerful reduction maneuvers, which now allow the spinal surgeon to correct severe, complex, and rigid spinal deformities. However, one of the major limitations of surgical intervention has been the high complication rates associated with these surgical endeavors. Much of the morbidity associated with posterior deformity surgery relates to the extensive soft tissue destruction necessary to gain access to multiple segments of the axial skeleton. The open exposures for long-segment fixation result in additional blood loss, increased rates of infection, and prolonged immobilization caused by postoperative pain. Minimally invasive techniques attempt to overcome these drawbacks of the open exposures, and this report reviews preliminary experience in treating spinal deformities with long-segment minimally invasive internal fixation.