The thoracolumbar junction is a site less commonly affected by degenerative disease but disproportionately affected by unstable spinal pathologies such as fractures, infections, and neoplasms. Varying approaches for the treatment of these pathologies have been historically described, but there has been a shift toward more pathology being treated by minimally invasive approaches. While a working knowledge of the open approach and its advantages and disadvantages is important, the MIS approach is favored where feasible due to being less disruptive with reduced cardiovascular, respiratory, muscular, and cosmetic morbidity. The unique anatomy of the thoracolumbar junction is discussed with respect to the separation of and structures relevant to the abdominal and thoracic cavities. Evaluation of and preparation for surgery of patients with thoracolumbar junction pathologies are also discussed. With considered techniques, an expansion of the safe treatment of spinal pathologies has been made possible.