“Minimally invasive” has become a convenient shorthand for good spine surgery. Smaller incisions and percutaneous techniques matter—but experienced surgeons know that tissue trauma is driven by cumulative insult, not labels. Muscle, nerve, and soft tissue respond to force, time, energy exposure, and repetition across the entire case. When MIS is reduced to fundamentals, the drivers of lower tissue trauma are consistent—and well supported in the literature. What Actually Makes the Difference...