The incidence of anterior lumbar surgery is increasing. Although adverse events are uncommon, several have been described. Complications can be categorized based on the time of occurrence (ie, intraoperative, postoperative), patient positioning, surgical exposure, and spinal procedure. Notable approach-related complications involve vascular, visceral, and neural structures. Abdominal complications have been reported. Clinically significant complications related to spinal decompression and reconstruction consist primarily of neurologic injuries and graft- and device-related problems. The rate of complications is higher in the setting of revision anterior surgery than with initial anterior lumbar surgery. A thorough understanding of the complications associated with anterior lumbar surgery will aid in prevention, recognition, and management of these rare problems. The assistance of a vascular, neurologic, or general surgeon may be helpful in avoiding or effectively managing complications.