Spinal column reconstruction for the management of spinal deformity is technically challenging and has been associated with high complication rates. The purpose of this article is to review the major complications associated with spinal deformity. Major complications include pseudarthrosis, proximal junction kyphosis, sagittal decompensation, deep wound infection, and neurovascular injury. The technology and instrumentation used to treat spinal deformity continue to develop, and the complication rates seem to be decreasing. Although only trends can be identified, complications are to be expected when performing this surgery. Awareness of the occurrence of complications can lead to better information and guidance of the surgeon's expectations as well as the patient's.