Spinal anesthesia is a commonly performed regional technique by a majority of the anesthesiologists worldwide. This technique is learnt early during training and relatively easy to master. Despite being the oldest regional anesthesia technique, it continues to evolve and develop in various aspects. This review attempts to highlight the recent advances in this 〞almost-perfect〞 technique with respect to indications, procedure, drugs, and strategies to minimize side effects. Understanding the finer aspects and knowledge gaps will help postgraduates and practicing anesthesiologists in designing patient specific techniques and interventions. This record is sourced from MEDLINE/PubMed, a database of the U.S. National Library of Medicine