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Introduction The use of minimally invasive techniques for spinal stabilization (MISS) is now widespread because of the theoretical advantage of lesser surgical aggression. However, there is no definitive evidence of its real advantage comparing to traditional open surgery (TOS). In this study, the authors compare both techniques according to safety and efficacy for the treatment of spinal instability. Patients and Methods This is a retrospective cohort study analyzing the records of the patients submitted to posterior dorsal or lumbar stabilization by MISS or TOS as treatment of instability because of trauma, infection, or tumor in a single center in the last 5 years (2009–2013). We compared both techniques according to efficacy (postoperative pain and deformity correction) and safety (accuracy of screw insertion, surgical and length of surgical time and hospital stay, complication occurrence Đ mortality, infection, neurological deterioration, instrumentation failure). Statistical analysis was performed with SPSS(R)17.0 surgeon preference dictated the technique chosen for each case. Results A total of 69 patients were treated, with a median follow-up of 21.6 ± 15 months. The populations (MISS/TOS) were not significantly different in the following: age, general medical status (ASA score), instability score (TLICS and SINS), osteoporosis incidence, lesion location, type of pathology, previous neurological state, or nonfusion risk factors. There was no statistical difference in postoperative pain ( p = 0.715) and immediate and late deformity correction ( p = 0.577 and p = 0.689). Screw insertion accuracy was significantly less in TOC ( p = 0.001) leading to more cases of revision surgery. Surgical time was not significantly different ( p = 0.08). Hospital stay was significantly shorter in MISS. Complication incidence was rare, but postoperative infection and neurological worsening was more frequent in TOS. Conclusion MISS is as effective as TOS and significantly safer than the later in what concerns to screw insertion accuracy and need for revision surgery. It does not take more OR time; and the length of stay at the hospital is shorter.