Anterior and posterior approaches for lumbar interbody fusion can be associated with a number of serious complications. Interest in minimally invasive approaches for interbody fusion has increased in recent years, with the goal of decreasing complications and patient morbidity. The goal of minimally invasive spine surgery is to decrease operative time, decrease blood loss, improve cosmesis, shorter hospital stays and faster recovery time. Extreme lateral interbody fusion (XLIF) is a relatively new technique whereby access to the disc space is achieved through a minimally invasive lateral, retroperitoneal, trans-psoas approach. The nerves of the lumbar plexus reside within the psoas, and the technique is dependent upon real-time electromyographic monitoring. The purpose of this review is to present an overview of the XLIF technique, with particular attention paid to indications, advantages, biomechanics, and early clinical and radiographic results.