The technology that is available in modern spine surgery is remarkable. We are now able to routinely perform procedures that we couldn’t even imagine thirty years ago. However, even as we grow in our ability to perform more complex procedures, the indications for surgery and suggested magnitude of the procedure has become increasingly unclear.

This section discusses the magnitude issue from a complexity perspective. We are concerned with these factors in spine surgery because the risk of complications grows with complexity of the procedure. Factors that reliably increase the complexity and risk are length of the surgery, blood loss, and tissue trauma. Other issues such as smoking, obesity, diabetes, kidney failure, heart problems, lung disease, liver failure, age and general conditioning also impact the outcome and decision-making.