The evolution of minimally invasive spine surgery techniques has emphasized achieving robust arthrodesis while minimizing perioperative morbidity and enhancing recovery times. Awake spine surgery involves a subset of interventions that incorporate nongeneral anesthetic protocols for select interventions, including decompression and fusion. Appropriate patient selection and enhanced recovery protocols are critical to ensure postoperative outcomes are maximized. Short-term and long-term studies find that awake techniques have lower complication profiles and improved recovery times while accomplishing the same ends of previously used open and MIS approaches.