Introduction: This study evaluated the importance of examining neuraxial anatomy by preprocedural ultrasonography to ensure effective spinal anesthesia administration, which can be technically challenging in geriatric patients owing to their physiological and pathological conditions. Materials and Methods: Geriatric patients with an American Society of Anesthesiologists' physical classification of I-III undergoing elective surgery under spinal anesthesia were included. The patients were divided into two groups: the anatomical landmark-guided group and the ultrasound-assisted group. Spinal block application times, number of attempts and number of needle redirections were recorded. Results: Among the studied patients, 29 and 30 patients were included in the anatomical landmark-guided group and the ultrasound-assisted group groups, respectively. There was no significant difference in the mean age of the patients in the ultrasound-assisted group (74.6 +/- 7.41 years) and the anatomical landmark-guided group (75.6 +/- 7.52 years). Assisted procedure time and total operative time were significantly shorter in the anatomical landmark-guided group than in the ultrasound-assisted group (p<0.001 and p<0.05, respectively); however, spinal application times and number of trials and needle redirections were significantly lower in the ultrasound-assisted group than in the anatomical landmark-guided group (p<0.05 and p <0.05, respectively). Conclusion: Preprocedural ultrasonography before spinal anesthesia administration increases the first-attempt success rate and decreases the number of attempts and needle redirections in geriatric patients.