Improvement of intraoperative surgical techniques while performing spinal procedures are owed to advances in the surgical instruments, optics, and approaches. Endoscopic surgery is one such technique that can enable minimally invasive decompression to take place, which may potentially lead to greater patient safety. Innovations in refined anesthetic protocols utilized while performing lumbar fusion without general endotracheal anesthesia represent a promising way to achieve conscious sedation, which may improve patient outcomes and prevent early postoperative complications. Other advances in the agents and medications used during surgery, such as tranexamic acid and orthobiologics, may help to mitigate intraoperative blood loss and lead to greater rates of fusion, respectively. Breakthroughs in virtual and augmented reality may also aid in the education of trainees and intraoperative visualization during surgery.