Awake surgeries are commonly performed in many specialties through the use of local or regional anesthesia. These methods avoid the risks associated with general endotracheal anesthesia and allow faster recovery times. In neurosurgery, awake surgeries are typically reserved for craniotomies involving tumor or lesion resection near eloquent tissue. Only recently has awake spine fusion surgery been performed, and only in very limited capacity. Here, we describe the first reported case of awake percutaneous transforaminal lumbar interbody fusion with robotic navigation and instrumentation under spinal anesthesia.