AIthough there is little question that spinal surgery can be highly beneficial in properly selected patients, all neuro-surgeons must contend with the universal probability of an intraoperative or postoperative complication occurring. Much of the surgical decision making and discussion with patients center around the issue of potential complications and how to prevent or address them. Surgeons depend on the medical literature to buttress their own experiences with complications to become better decision makers and counselors. To date, the medical literature has been limited with regard to honest appraisals of complication rates. This situation is due to a multiplicity of factors, including (i) the fact that there is a tendency for surgeons to avoid publishing poor outcomes in the peer-reviewed literature, (ii) the fear of medicolegal risks or implications, (Hi) the lack of active surveillance for detecting complications, and (iv) differing views of what events should be classified as a complication.
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