Background: Patients above the age of 65 have an increased risk of adverse effects from anesthesia up to death. For elderly people with a variety of medical conditions, spinal anesthesia is the preferable method of anesthesia. After surgery, spinal anesthesia provides excellent postoperative pain control and reduces the perioperative opioid use, which minimizes opioid adverse effects. Spinal anesthetic is traditionally administered with the use of palpation of specific anatomical landmarks. Ultrasonography (US) has brought a revolutionary improvement in anesthesiology. Using ultrasound prior to neuraxial blocks can increase the success rate on the first attempt, minimize the number of attempts, and enhance both clinical as well as technical consequences. Subarachnoid space depth measurement can be performed using ultrasound to locate the spine's midline and intervertebral level as well as guides the correct needle insertion location and needle insertion angle. Objective: This study aimed to determine the role of ultrasound-guided spinal anesthesia in geriatric persons receiving lower limb surgery. Methods: PubMed, Google scholar and Science direct were searched using the following keywords: Spinal anesthesia, ultrasound guided and elderly. The authors also screened references from the relevant literature, including all the identified studies and reviews, only the most recent or complete study was included. Documents in a language apart from English have been excluded as sources for interpretation. Papers apart from main scientific studies had been excluded (documents unavailable as total written text, conversation, conference abstract papers and dissertations). Conclusion: There are numerous researches and evidence-based guidelines supporting the use of US neuraxial blocks that are safer and more convenient especially in elderly patient with age-related spinal changes.