Transient neurologic symptoms (TNS) refer to self-limiting pain in the lower back, buttocks, or lower extremities following spinal anaesthesia, typically appearing within 24 hours and resolving within 2–5 days. The incidence of TNS varies based on the local anaesthetic used, with lidocaine carrying the highest risk (up to 30%), while bupivacaine, prilocaine, and ropivacaine have lower rates. The exact pathophysiology remains unclear, but proposed mechanisms include neurotoxicity from local anaesthetics, musculoskeletal strain, patient positioning (e.g., lithotomy), and anatomical variations in spinal curvature. Prevention strategies involve using alternative local anaesthetics, minimizing high-concentration lidocaine doses, limiting lithotomy positioning duration, and employing multimodal analgesia with NSAIDs like ketorolac. TNS is primarily managed with NSAIDs, opioids if necessary, and reassurance, as it does not lead to permanent neurological damage. Patients with severe or prolonged symptoms should undergo further neurological evaluation. Although TNS may cause temporary discomfort, it does not significantly impact patients’ willingness to receive future spinal anaesthesia. Proper patient education about TNS as a potential adverse effect is crucial in shared decision-making for spinal anaesthesia. This article provides insights into the incidence, risk factors, mechanisms, prevention, and management of TNS.