Experienced spinal surgeons from around the world share knowledge they have gained from dealing with complex cases. They use a case report format to illustrate the challenges, pitfalls, pearls, and techniques encountered in managing such cases. Not all of the cases are success stories. The cases are presented in sections on early onset scoliosis, pediatric spinal deformity, adult spinal deformity, trauma and tumors, and the cervical spine. Among the topics are severe scoliosis in three young children treated with shilla, staged anterior release and posterior instrumentation for severe rigid adolescent idiopathic scoliosis, high-grade spondylolisthesis treated with transfixation, post-traumatic lumbar kyphotic deformity, and the complex reconstruction of the metastatic spine disease. Annotation ©2015 Ringgold, Inc., Portland, OR (protoview.com)