Spirocyclic tetrahydroquinolines (spiro-THQs) and tetrahydroisoquinolines (spiro-iTHQs), along with their derivatives, constitute a prominent class of natural products that exhibit a broad spectrum of biological activities. Due to their pharmacological importance, a series of asymmetric methods has been developed for constructing these frameworks. The present review offers a comprehensive and up-to-date overview of recent advances in the enantiostereoselective synthesis of these frameworks, aiming to provide a reference and inspiration source for researchers in organic synthesis and drug discovery.