Spinal surgery is a high-risk specialty with an ever-increasing patient volume. Results are very largely favorable, but neurologic damage, the most severe complication, may leave major sequelae, some of which can be life-threatening. Neurologic complications may be classified according to onset (per- vs. postoperative) and surgical site (cervical vs. thoracolumbar). The present paper provides quantitative data for the risks involved. Knowledge of these complications and their risk of onset is the best means of guiding prevention strategies. The spine surgeon is part of a multidisciplinary team, with the radiologist and electrophysiologist, which is able to identify risk factors preoperatively and diagnose neurologic complications per- or postoperatively.