Finite element modelling of the lumbar spine is a challenging problem. Lower back pain is among the most common pathologies in the global populations, owing to which the patient may need to undergo surgery. The latter may differ in nature and complexity because of spinal disease and patient contraindications (i.e., aging). Today, the understanding of spinal column biomechanics may lead to better comprehension of the disease progression as well as to the development of innovative therapeutic strategies. Better insight into the spine’s biomechanics would certainly guarantee an evolution of current device-based treatments. In this setting, the computational approach appears to be a remarkable tool for simulating physiological and pathological spinal conditions, as well as for various aspects of surgery. Patient-specific computational simulations are constantly evolving, and require a number of validation and verification challenges to be overcome before they can achieve true and accurate results. The aim of the present schematic review is to provide an overview of the evolution and recent advances involved in computational finite element modelling (FEM) of spinal biomechanics and of the fundamental knowledge necessary to develop the best modeling approach in terms of trustworthiness and reliability.