Background: Managing anaesthesia in patients with spinal deformities presents unique challenges. We report a case of successful subarachnoid block (SAB) in a patient with congenital retrolisthesis, who also presented with a lower respiratory tract infection (LRTI) contra indicating general anaesthesia (GA). Case description: A 26-year-old female with congenital retrolisthesis and lumbar spine deformity underwent an elective lower segment caesarean section (LSCS) under SAB. Detailed pre anaesthetic evaluation, risk counselling and a tailored approach were employed to address anatomical and physiological challenges. The procedure was uneventful; however a delayed regression of sensory and motor block was observed post operatively. Conclusion: neuraxial anaesthesia, despite challenges, can be safely administered in parturient with spinal deformities through meticulous planning and monitoring. This case highlights of individual anesthetic approaches in complex clinical scenarios.