More than 20,000 spinal operations are carried out in the UK each year. The decision when and whether to operate requires mature judgement. Spinal surgery is technically difficult, demanding a high level of surgical skill. It is learnt only by lengthy apprenticeship. The after-care is equally important. The personal supervision of the surgeon who leads a coordinated team of clinicians, nurses and physiotherapists will ensure the best results. It is inevitable and unfortunate that mistakes will occasionally be made and only careful attention to detail in the pre-operative assessment, meticulous surgical care and supervised post-operative management will ensure consistently good results. The spinal surgeon needs to remain up-to-date, be disciplined with a systematic and careful approach and lead a coordinated team to maintain the highest standards.