All surgical procedures involve risks. This issue of Neurosurgery Clinics investigates ways to minimize complications in complex spine surgery. Article topics include intraoperative neurophysiologic monitoring, blood loss minimization, cervicomedullary compression and occipitocervical instability, iatrogenic cervical deformity, multilevel cervical spondylosis, cervicothoracic kyphosis, and degenerative lumbar scoliosis.