Objective: Older patients undergoing spine surgery present unique challenges due to age-related physiological changes and comorbidities. The choice of anesthetic plays a pivotal role in perioperative outcomes, yet limited data exist on optimal approaches in this vulnerable population. This study compared the safety and efficacy of general anesthesia (GA) versus spinal anesthesia (SA) in patients over 65 years of age undergoing lumbar spine surgery. Methods: A retrospective analysis was conducted on 150 patients over 65 years of age undergoing lumbar spine surgery between January 2021 and December 2023. Patients were equally divided into GA (n=75) and SA (n=75) groups. Demographics, surgical parameters, intraoperative data, and postoperative outcomes, including visual analogue scale (VAS), Oswestry Disability Index (ODI), time to analgesic requirement, length of hospital stay, and complication rates, were analyzed. Results: Baseline demographics and surgical parameters were comparable between groups. SA was associated with significantly lower VAS scores at 48 hours (3.02±0.60 vs. 4.65±0.68, p<0.001) and better ODI scores (38.94±4.12 vs. 43.25±4.75, p<0.001) compared to GA. Time to first analgesic requirement postoperatively was significantly delayed in SA (151.73±12.45 minutes vs. 61.25±5.82 minutes, p<0.001), along with shorter hospital stay (2.74±0.68 days vs. 3.24±0.74 days, p<0.001). Complication rates were comparable, though nausea/vomiting was significantly lower in patients who received SA (6.7% vs. 16%, p=0.04). Long-term VAS and ODI scores at 1 year were similar between groups. Conclusion SA offers significant early postoperative advantages in lumbar spine surgery in older patients, including superior pain control, faster recovery, and shorter hospitalization, without affecting long-term outcomes. It represents a safe and effective alternative to GA in older spine surgery patients.