A dedicated team for complex spine surgeries can improve the risk profile of challenging cases. This team may include OR personnel dedicated to spine surgery, an anesthesiologist experienced in pediatric spine surgery, an experienced neurophysiologist, a plastic surgeon, and, in certain instances, a second attending spine surgeon. Adherence to checklists and best practice guidelines reduces the cognitive load on surgeons and promotes excellent, reproducible outcomes. Cases where neurological injury, extensive blood loss, or delayed postoperative healing are a concern may benefit from the creation and deployment of a “high-risk complex spine team.”