Spinal deformity surgeons should be attuned to factors that may stratify patients as being at high risk for intervention, relating to neurological issues. Factors contributing to this designation may be patient-related, curve-related, or spinal cord-related or they may be intraoperative surgical factors. Identifying patients as high risk can allow the surgical team to employ preventative measures to mitigate the risk of intra- or perioperative neurological issues. It is useful to maintain a working knowledge of recently published guidelines/checklists that can help the surgical team navigate intraoperative neuromonitoring events in patients with complex spinal deformity.