Awake spine surgery offers a crucial alternative for individuals deemed high-risk or outright unsuitable for general anesthesia, often due to severe cardiopulmonary conditions, advanced age, or other significant comorbidities that could be exacerbated by systemic sedation. By employing regional anesthesia, such as epidural or spinal blocks, combined with light sedation, patients can remain conscious and comfortable throughout the procedure while avoiding the profound physiological stressors associated with intubation, ventilation, and the widespread effects of general anesthetic agents. Awake Spine Surgery not only enhances safety by mitigating the risks of respiratory and cardiac complications but also allows for real-time neurological monitoring through patient feedback, ensuring a safer and more tailored surgical experience for this vulnerable population.