Background: Managing capillary bleeding during lumbar spine surgery is crucial for improving surgical outcomes. Both dexmedetomidine and clonidine are α-2 adrenergic agonists used to achieve controlled hypotension, reducing intraoperative blood loss and enhancing the visibility of the surgical field. This study aims to compare the hypotensive properties and overall efficacy of dexmedetomidine and clonidine in patients undergoing lumbar spine surgery. Methods and Methodology: This prospective, randomized, double-blind interventional study included 60 patients undergoing elective lumbar spine surgery. Patients were randomly assigned to receive either dexmedetomidine (Group A) or clonidine (Group B). Group A received dexmedetomidine 1 µg/kg in 10 ml saline over 10 minutes, followed by a 1 µg/kg/hr infusion. Group B received clonidine 2 µg/kg in 10 ml saline over 10 minutes, followed by a 1 µg/kg/hr infusion. Hemodynamic parameters, including heart rate (HR), systolic blood pressure (SBP), diastolic blood pressure (DBP), mean arterial pressure (MAP), and oxygen saturation (SpO2), were recorded at various time points. The primary outcome measured was the efficacy in maintaining controlled hypotension and providing an oligemic surgical field. Results: Dexmedetomidine was associated with a significantly lower mean heart rate at several time points and a longer time to first analgesia request (11.50 ± 1.49 minutes) compared to clonidine (6.99 ± 0.94 minutes, p < 0.001). Both drugs effectively maintained controlled hypotension, with dexmedetomidine showing a slightly better profile in terms of heart rate control and postoperative analgesia duration. Conclusion: Both dexmedetomidine and clonidine are effective in achieving controlled hypotension during lumbar spine surgery. Dexmedetomidine provides better heart rate control and prolonged postoperative analgesia compared to clonidine, making it a preferable choice for improving surgical field visibility and patient outcomes.