The paraspinal approach was described by our group in 1968. It differs from the approach described by Melvin Watkins in 1953 in that it is a longitudinal separation of the sacrospinalis group between the multifidus and longissimus, and not between the lateral border of the entire sacrospinalis group and quadratus lumborum. Also, Watkins removed a flake of the iliac crest with muscles attached, which he swung cranially and medially. This article also describes several refinements not mentioned in the original article and gives several new uses for the approach. Specifically, its use for removing a far lateral disc, decompressing a far out syndrome, inserting pedicle screws, and for decompressing the opposite side from inside the vertebral canal is described.