The complications of 648 consecutively inserted Universal AO pedicle screws (140 in the thoracic spine and 508 in the lumbar spine) performed by one surgical team to treat 91 patients with spinal problems, were reviewed. The spinal pathology consisted of: scoliosis (34 patients), degenerative lower lumbar spinal disease (25 patients), neoplastic spinal disease (11 patients), thoracic kyphosis (8 patients), spinal fractures (7 patients), lumbo-sacral spondylolisthesis (3 patients), and osteomyelitis (3 patients). Intraoperative complications were: screw misplacement (n = 3), nerve root impingement (n = 1), cerebrospinal fluid leak (n = 2) and pedicle fracture (n = 2). Postoperative complications were; deep wound infection (n = 4), screw loosening (n = 2) and rod-screw disconnection (n = 1). The conclusion was that pedicle screw fixation has an acceptable complication rate and neurological injury during this procedure is unlikely.