Yagi M, Michikawa T, Hosogane N, et al. - Record from a multicenter database for 285 consecutive surgically treated adult spinal deformity (ASD) patients who had reached a 2-year follow-up was reviewed to inform the risks, recovery, and clinical influence of neurological complications (NCs) in ASD surgery. In 29 patients, NC developed within 30 days of surgery, of which 11 were permanent deficiencies (seven no recoveries, and four partial recoveries). In 14 patients, MD developed, including one spinal cord injury. At the latest follow-up, seven MD patients needed physical assistance. While NC patients encountered notable betterments in health-related quality of life at the 2-year follow-up, the health-related quality of life was significantly worse for the NC in comparison with the no-NC group at this time point. Risk factors for MD were Schwab-SRS types N and L, pelvic tilt, modified frailty index physical function, and an inferior SRS22 function domain at baseline. Among them, modified frailty index physical function, which represented a preoperative deterioration in activities of daily living, was recognized as an independent risk factor for MD. Thus, in 10% of ASD surgery patients, NC developed, along with 4% with permanent deficits. Half of the patients who developed MD needed physical assistance, which added to the inferior clinical outcomes. Surgical intervention should be acknowledged former to serious activities of daily living deterioration to limit NCs.