Awake lumbar spine surgery represents a growing subset of spine interventions that incorporate non-general anesthetic for a select set of interventions. Perioperative workflows and enhanced recovery protocols emphasize durable multimodal pain management, conscious sedation, and local/regional anesthetic techniques for improved postoperative outcomes. Awake techniques increasingly are found to have lower complication profiles and faster recovery rates compared to general anesthetic. Further study is encouraged to identify the optimal use cases for such modalities.