Background: Comparison between spinal anaesthesia with conventional land mark (blind) technique and with preprocedural ultrasonographic guidance technique. Ultrasound (US) can be used effectively and accurately to identify the anatomical landmarks of neuraxial blockade, in order to improve the safety and efficacy of spinal anaesthesia. Objective: To assess the effectiveness and safety of US to improve the technique of spinal anaesthesia, anddecrease it's complications in comparison to the conventional landmarks technique. Patients and Methods: The study was performed in Zagazig University Hospital. Hundred and four ASA classes I and II adult cooperative patients of both sexes were scheduled for surgery in the lower part of the body under neuraxial blockade. They were randomly allocated into two equal groups, preprocedure ultrasonography guided spinal anaesthesia (PS) group, and conventional landmark group (CL). Results: It was found that there was a statistically significant difference between PS and CL groups regarding the number of attempts, number of needle pass (bone hitting), successful dural puncture after the first attempt, and total time for technique performance. Conclusion: ultrasound guidance improves the success rate of midline spinal anaesthesia. It reduces the number of attempts required, improves the success rate of a single needle pass, and shortens the time to dural puncture. Further trials can be done to establish the role of ultrasound-guided neuraxial block among high-risk groups, such as obese, elderly, and patients with spinal deformity.