This chapter explores the risks associated with different surgical approaches to the lumbar spine, particularly the potential impact on neurological and vascular structures. It emphasizes the importance of employing a multimodal neuromonitoring strategy, specifically tailored to the unique demands of each procedure, to provide the most accurate assessment of nervous system function. This approach is shown to significantly improve patient outcomes by reducing the risk of intraoperative neurological damage. The chapter also highlights the critical role of the neurophysiologist’s comprehensive understanding of both the surgical anatomy and the procedural steps, which is vital in minimizing the likelihood of false data interpretation. Furthermore, it underscores the importance of effective communication among the surgical team, including the surgeon, neurophysiologist, and anesthesiologist, as a key factor in achieving optimal surgical outcomes.