Objective: To compare the advantages and disadvantages of the improved fine needle paramedian approach and the traditional needle approach for spinal anesthesia in the cesarean section. Methods: According to the method of random number table, 90 cases of cesarean section were divided into 3 groups: a traditional needle median approach group (TM group), an improved 25G fine needle median approach group (IM group), and an improved 25G fine needle paramedian approach group (IPM group), 30 cases in each group, respectively. The number of punctures, the puncture time, the number of puncturing the bones, the heart rate and blood pressure before and after anesthesia, and the incidence of headache or lumbago 24 h and 6 days after the operation were observed. Results: Compared with the TM group, IM group and IPM group had fewer puncture times and bone puncturing (P<0.05), shorter puncture time (P<0.05), and lower incidence of postoperative lumbago (P<0.05). There was no significant difference in other indexes among the 3 groups (P>0.05). Conclusion: Compared with the traditional method, the improved method has fewer puncture times, shorter puncture time, fewer bone puncturings, and lower incidence of postoperative lumbago.