The development of alternative approaches to spine disorders marked an evolutionary change in the methods by which surgeons address diseases that affect the ventral portion of the spine. From the advent of spinal surgery until quite recently, physicians used posterior approaches almost exclusively for the treatment of all pathological processes. Surgeons subsequently became frustrated and disenchanted with outcomes of patients with anterior vertebral body disease when these procedures were applied. This sentiment is best reflected in the surgical thought related to Pott disease. In this paper, the authors chart the development of an influential approach to the spine that is designed to address these issues: the lateral extracavitary approach. They trace its origins to early precursor procedures and follow its use in current practice for the treatment of a variety of spinal disorders. They also examine its applications, role, and continued importance in the age of minimally invasive surgery.