Posterior and posterolateral approaches to the spine are designed to allow anterior debridement and reconstruction whilst also permitting posterior instrumentation and decompression. A transpedicular approach allows anterior access for decompression and debridement but insertion of a strut graft may be difficult. Hence, it is primarily indicated in patients with peridiscal lesions with neurologic deficit who do not have a significant deformity or significant bone destruction. The costotransversectomy approach and the lateral extracavitary approach allow anterior strut grafting and hence are preferred when there is compete destruction of a vertebra resulting in a significant kyphotic deformity. The lateral extracavitary approach is also useful when performing vertebral column resections for the correction of post-tubercular kyphosis. In the lumbar spine, posterior approach is primarily restricted to performing supplementary posterior instrumentation or for a TLIF-like procedure in patients with juxta-discal lesions.