What are the risks associated with orthopedic spinal deformity surgery? Most orthopedic spine surgery is safe and effective. However, as with any other surgery, there are inevitably some risks and complications: adverse reactions to anesthesia and pain medications; pneumonia and other complications. Because of the unique nature of the spine itself, patients are far more concerned about spine surgery than surgery on the extremities. Spine surgery involves larger incisions and more bleeding. But most of all, spinal surgery can lead to complications of spinal cord injury and possibly paralysis. Fortunately, the incidence of complications like spinal cord paralysis and other serious spinal cord injuries is in the thousands, especially in routine surgery for idiopathic scoliosis, where the incidence of nerve damage is quite rare. Is there any chance of paralysis or death during surgery? The incidence of paralysis during routine surgery for idiopathic scoliosis is in the thousands. Most scoliosis patients are relatively healthy except for the scoliosis, so the routine postoperative complications are rarely fatal. One of the few potentially fatal complications is pulmonary embolism, which can occur with any surgery and is not limited to scoliosis surgery. As with paralysis, the likelihood of death from scoliosis surgery is in the thousands. Therefore there is no need to forgo surgery for fear of complications such as paralysis and death from scoliosis. However, it should be noted that the risk of surgery is greatly increased in patients with complex scoliosis (e.g., neuromuscular scoliosis, degenerative scoliosis, severe scoliosis, surgical revision of scoliosis, etc.) and in older patients with other accompanying medical problems. However, even in these patients, the incidence of complications is very low. How long does the surgery take? A conventional anterior or posterior surgery lasts 3 to 4 hours. An additional 2 hours or more is spent on preparation, positioning and awakening. Patients with increased lordosis, longer segments and older patients require a longer surgery, which can last 6 to 7 hours. Anterior-posterior one-stage surgery can take 7 to 8 hours. Why do I need to place an internal fixation? Various types of internal fixation such as rods, hooks, wires and screws are used to support the spine in its post-orthopedic position until the implants are fused. Internal fixation is also a tool for scoliosis correction. However, internal fixation is not effective without strong bone fusion.