Sonographic guidance for lumbosacral regional anesthesia and chronic pain management procedures is rapidly evolving. An in-depth understanding of anatomy is important to enable correct identification of sonographically visualized structures. When compared to palpation-guided techniques, sonographically assisted procedures have been shown to improve clinical outcomes. When used for chronic pain management lumbar spine procedures, sonography has certain visualization advantages and limitations compared to fluoroscopy. Great strides have been made in the advancement of sonography as a primary visualization technique for specific lumbosacral spine procedures. Further advancements in sonographically guided scanning techniques and equipment development are needed to overcome some of the current sonographic visualization limitations for lumbosacral procedures. In addition, future studies are needed to evaluate the safety and efficacy of sonographically guided techniques for lumbosacral procedures.