Percutaneous fixation was introduced by Magerl et al. in 1977 for the external fixation of the spine in patients, who required transitory stability for traumatic and infectious causes. Percutaneous targeting techniques have gradually improved and have led to the expanded use of these fixation methods. Instrumentation is now available that can be used to perform lumbar and thoracic fixation by placing rods that are curved freehand to the desired shape, without limitation on the number of levels instrumented. The advantages of percutaneous pedicle screw fixation relative to open surgery are: less blood loss, shorter operative time, lower infection risk, less postoperative pain, shorter rehabilitation time as well as shorter hospital stay. Percutaneous lumbosacral pedicle screw placement using intraoperative dual-planar fluoroscopy is a safe technique with low rates of complication and revision. This could pose an obstacle in the way of practicing this technique in developing countries due to limited resources as providing two fluoroscopy devices in a single operating theatre is rarely possible.