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Background and Aims Myotonic dystrophy type 2 (DM2) is a multisystemic neuromuscular disorder with implications for anesthetic management, particularly due to risks associated with general anesthesia such as respiratory depression, cardiac conduction defects, and sensitivity to muscle relaxants. Regional anesthetic techniques, such as regional anesthesia, are often considered safer in these patients. This report aims to illustrate the clinical decision-making process leading to the successful use of spinal anesthesia in a DM2 patient undergoing vaginal hysterectomy for uterine prolapse.Methods A 68-year-old female with diagnosed DM2 and symptomatic grade 3 uterine prolapse was scheduled for elective vaginal hysterectomy. Preoperative evaluation showed mild proximal muscle weakness, preserved pulmonary function, and no cardiac conduction abnormalities. Considering her neuromuscular condition and the regional nature of the surgical field, spinal anesthesia was chosen to minimize systemic risks. A single-shot spinal block was performed at L3-L4 using 3 mL of 0.75% hyperbaric ropivacaine with 20 mcg fentanyl.Results The block achieved a T6 sensory level with adequate motor blockade within 5 minutes. The procedure l was completed without hemodynamic instability or need for sedation. The patient remained comfortable and responsive throughout. Postoperatively, no respiratory complications, prolonged motor block, or myotonia exacerbation occurred. The patient mobilized on postoperative day 1 and was discharged home on day 3 without adverse events.Conclusions This case highlights the value of individualized anesthetic planning in patients with DM2. Spinal anesthesia can be a safe and effective choice for pelvic surgery, avoiding the potential complications of general anesthesia. Careful preoperative assessment and vigilant intraoperative monitoring are essential for optimal outcomes.