Techniques of percutaneous spinal instrumentation have in the meantime become standard methods in many hospitals. While several indications have been established that are excellently suited to this technique, uncertainty prevails for other indications. This contribution intends to clarify the technical prerequisites for performing percutaneous instrumentation in the region of the thoracic and lumbar spine in addition to describing customary indications and various techniques of percutaneous instrumentation. This is combined with a critical assessment of what intrinsically cannot or cannot yet be achieved with a percutaneous approach to illustrate that the percutaneous procedure can by no means be considered a mere evolution of the previous classic open techniques.