MISS procedures for fusion and decompression are performed using tubular retractors. The surgeon makes a small incision in the skin and soft tissues and inserts the tubular retractor until it reaches the spinal column, creating a tunnel through which the surgeon can access the spine. The retractor allows devices such as screws and rods to be inserted. Fluoroscopy allows the surgeon to see a real-time x-ray image of the patient’s spine, and an operating microscope can also be used to allow the surgeon to see the procedure. When the tubular retractor is removed, the muscles can return to their original positions, limiting muscle damage. Contrary to popular belief, lasers are rarely used in MISS procedures.