Neuraxial blockade is still largely performed as a blind procedure. Despite of developments in the type of needles used and drugs administered, the process of locating the epidural or intra-thecal space is still limited to identification of landmarks by palpation and reliance on tactile feedback of the operator. Ultrasound has provided the long needed "eye" to the procedure and has already shown promise of improving the safety and efficacy or neuraxial blocks. This review focuses on understanding the sonoanatomy of the neuraxial space, performing a systematic pre-procedural ultrasound scan, and reviewing the available evidence.