Awake spinal fusion might someday prove to be an invaluable new paradigm in surgery for the back, really prioritizing the patient's comfort and recovery. It also minimizes the general risks associated with intubation and sedation and increases speed in recovery while minimizing post-operative complications like nausea and cognitive dysfunction. This allows patients suffering from chronic back pain conditions like spinal stenosis or spondylolisthesis to return more quickly to functional activities and dramatically enhances their quality of life. The patient can communicate with the surgeon during the entire procedure, permitting continuous real-time evaluation of the neurological function, which may minimize the risk of nerve damage and the optimal placement of the implants. It is not for all, though; however, awake spinal fusion advances spinal surgery in many ways and offers a less invasive and possibly more effective alternative only for specific patients wanting to be free from debilitating back pain.